LIBRARY OF CONGRESS, 

§§ap &pnri#^0 

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> V O a 

UNITED STATES OF AMERICA. 



NURSING IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 



FULLERTON. 



THIRD REVISED EDITION. JUST READY. 



A HANDBOOK 



OBSTETRICAL NURSING; 

Comprising the Course of Instruction in Obstetrical Nursing 

given to the Pupils of the Training School for Nurses 

connected with the Woman's Hospital of Philadelphia. 

BY ANNA M. FULLERTON, M.D., 

Demonstrator of Obstetrics in the Woman's Medical College of Pennsyl- 
vania ; Physician-in- Charge and Obstetrician and Gynecologist to the 
Woman's Hospital of Philadelphia, and Superintendent of the 
Nurse Training School of the Woman's Hospital of Philadelphia. 

38 Illustrations. 12mo. Handsome Cloth, $1,25. 

Synopsis of Contents. — The Pelvis and Genital Organs — 
Signs of Pregnancy — Management of Pregnancy — Accidents of 
Pregnancy — Germs and Antisepsis — Application of Antisepsis to 
Confinement Nursing — Preparations for the Labor — Signs of Ap- 
proaching Labor and the Process of Labor — Duties of the Nurse 
during Labor — Accidents and Emergencies of Labor — Care of the 
New-born Infant — Management of the Lying-in — Characteristics 
of Infancy in Health and Disease — The Ailments of Early In- 
fancy — Index. 

" It is a book that I have recommended since I first saw it, and we are using 
it for our nurses at the N. Y. Infirmary, where we have a branch of our School, 
our nurses going there for instruction in obstetrics." — Mrs. L. W. Quintard, 
Supt. Connecticut Traijiing School for Nurses, New Haven, Conn. 

" It is the most modern and complete book I have ever read for the care of 
obstetrical patients. I shall take pleasure in recommending it to this school for 
study." — E. L. WarRj Supt. Training School for Nurses, City Hospital, St. 
Louis, Mo. 

, " I have looked it over and read it with care, and think it is the best book I 
have ever seen on the subject. It is practical, with plain instructions, nothing 
superfluous. A good book for nurses and teachers of nurses." — Miss Anna 
G. Clement, Supt. of Nurses, The Henry W. Bishop Memorial Training 
School for Nurses, Pittsfeld, Mass. 

" I consider the book excellent in every particular. Would recommend it to 
every nurse, whether she did obstetrical nursing or not." — Gertrude Mont- 
fort, Supt. of Nurses, New England Hospital for Women and Children, 
Boston, Mass. 

" What is to be learned in a maternity training school is the way to nurse as a 
profession. * * * Can recommend it as a valuable manual." — From the Amer- 
ican Journal of Medical Sciences. 



NURSING IN 



ABDOMINAL SURGERY 



AND 



DISEASES OF WOMEN. 



A SERIES OF LECTURES DELIVERED TO THE PUPILS OF THE 

TRAINING SCHOOL FOR NURSES CONNECTED WITH 

THE WOMAN'S HOSPITAL OF PHILADELPHIA, 

COMPRISING THEIR REGULAR COURSE OF 

INSTRUCTION ON SUCH TOPICS. 



BY 

ANNA M. FULLERTON, M.D., 

PHYSICIAN-IN-CHARGE OF AND OBSTETRICIAN AND GYNAECOLOGIST TO THE 
WOMAN'S HOSPITAL OF PHILADELPHIA, ETC. 



SECOND EDITION, REVISED AND E 

ILLUSTRATED, 

PHILADELPHIA : Zfrjljjf 

P. BLAKISTON, SON & CO., 

IOI2 WALNUT STREET, 
I8 93 . 




t- 



1^ 



AS 



Copyright, 1893, BY Anna M. Fullerton, m.d. 



PRESS OF WM. F. FELL & CO., 

1220-24 SANSOM STREET, 

PHILADELPHIA, 



\ 



TO 

The Woman's Hospital of Philadelphia, 

WHERE MANY WOMEN, 

BOTH PHYSICIANS AND NURSES, 

HAVE BEEN TRAINED FOR EFFICIENT SERVICE 

IN THE CARE OF THE SICK, 

I RESPECTFULLY DEDICATE 
THIS BOOK. 



PREFACE TO SECOND EDITION. 



In this second edition of my book, I have 
endeavored to make such additions to the chapters 
pertaining to the subject of sterilization as may 
meet all the requirements of asepsis and antisepsis 
in the present day. Further details as to the 
methods to be employed by the nurse in the 
preparation of antiseptic solutions, and fuller 
particulars as to the management of patients after 
operation and during convalescence, have also been 
added. 

ANNA M. FULLERTON. 

Womarfs Hospital. 



Vll 



PREFACE. 



Many books have been written within recent 
years on the subject of abdominal and gynaecolog- 
ical surgery, for the instruction and guidance of the 
medical student and practitioner, yet none but the 
most meager details — found chiefly in books on 
general nursing — have been supplied for the aid of 
the nurse. 

The stringent requirements of aseptic and anti- 
septic surgery demand that nurses and assistants 
shall cooperate with the surgeon in enabling him 
to attain the results desired in operative work. 
Hence a thorough knowledge of the methods by 
which the best results are to be obtained is essen- 
tial. At the request of my pupils — and with the 
hope of meeting this need in other institutions — 
I have prepared these lectures for publication. 
The methods recommended are those which have 
proved useful and successful in the surgical work 
of the wards of our Hospital. An effort has been 
made, however, by careful observation of the work 
in prominent hospitals both in this country and 
Europe, as also by a thorough study and com- 
ix 



X PREFACE. 

parison of the methods advocated by standard 
writers, to represent the various plans of manage- 
ment which tend to serve the same end. 

The chapter on diet for the sick has kindly been 
prepared by our matron, Miss Sara H. Janvier, and 
contains recipes for invalid cookery which are 
taught our nurses in the diet kitchen connected 
with the Hospital, in which each nurse has a 
term of service. 

I am indebted to Dr. Anna E. Broomall for many 
practical points in connection with the methods of 
management set forth in this book ; also, to Dr. 
Susan Hayhurst, Dr. Frieda E. Lippert, and Miss 
Alice Littell for aid in its compilation. To all who 
have helped me by friendly counsel and assistance 
I would express my sincere thanks. 

ANNA M. FULLERTON. 

Womarts Hospital of Philadelphia , 
Octobe?^ i8gi. 



i 

CONTENTS. 

CHAPTER I. PAGE 

The Surgical Nurse, 17 

CHAPTER II. 
The Germ Theory of Disease, 25 

CHAPTER III. 
Asepsis and Antisepsis, 31 

CHAPTER IV. 
Abdominal Section, 45 

CHAPTER V. 
The Preparation of the Room, 52 

CHAPTER VI. 
The Preparation of Sponges, 71 

CHAPTER VII. 
Sterilization of Instruments, Etc., 77 

CHAPTER VIII. 
Preparation of the Patient, 94 

CHAPTER IX. 
Preparation of Operator and Assistants, ...... 103 

CHAPTER X. 

The Nurse's Duties during Operation, 110 

xi 



Xll CONTENTS. 

CHAPTER XL PAGE 
The Nurse's Duties after Operation and during Con- 
valescence, 114 

CHAPTER XII. 
Management of Complications, 146 

CHAPTER XIII. 
The Pelvic Organs in Women, 168 

CHAPTER^ XIV. 
Diseases of Women, 175 

CHAPTER XV. 
General Nursing in Pelvic Diseases, 184 

CHAPTER XVI. 
Preparations for Gynecological Examinations, ... 201 

CHAPTER XVII. 
Preparations for Gynaecological Operations, . - . . 215 

CHAPTER XVIII. 
Preparation of Patient, Operator, and Assistants, . 225 

CHAPTER XIX. 
Duties of Nurse during Operation, 230 

CHAPTER XX. 

Special Nursing in Gynaecological Operations, . . . 233 

CHAPTER XXI. 

Diet for the Sick, 268 

Index, 297 



ILLUSTRATIONS. 



FIG. PAGE 

1. Sterilizing Oven, 33 

2. Abdominal Organs, 46 

3. Vertical Section of Pelvic Organs, 47 

4. Steam Atomizer, 56 

5. Diagram showing Position of Operator, Assistant, etc., . 62 

6. Diagram showing Position of Operator, etc., when two 

Assistants, 63 

7. Glass Graduate with Thermometer, 67 

8. Apparatus for Irrigation of Abdominal Cavity, 69 

9. Arnold Steam Sterilizer, 78 

10. Ignition Tube, cont. Glass Reels, wound with Silk, etc., . 86 

11. Ignition Tube, cont. Glass Reels, 86 

12. Needle Holder, 88 

13. Scalpels, 89 

14. Pressure Forceps, 89 

15. Grooved Director, 89 

16. Curved and Bent Scissors, 90 

17. Trocar and Canula, 90 

18. Volsella, 90 

19* Cyst Forceps, 91 

20. T-Forceps, , 91 

21. Retractor, 92 

22. Pedicle Needle, 92 

xiii 



XIV ILLUSTRATIONS. 

FIG. , PAGE 

23. Serre Nceud, 92 

24. Pedicle Pins, . 93 

25. Aseptic Razor with Metallic Handle, . 96 

26. Arrangement of Operating Pad in Abdominal Section, . . 101 

27. Hypodermic Needles and Syringe, 116 

28. Davidson Syringe, 118 

29. Glass Catheter, 124 

30. Coach Urinal, , 125 

31'. Female Urinal, . 126 

32. Feeder, 129 

33. Slipper Bed-pan, 130 

34. Eureka Bed-pan, 131 

35. Rubber Air-cushion, 133 

36. Glass Drainage Tube, . 134 

37. Glass Syringe for Draining Tube, 134 

38. Hard Rubber Syringe for Draining Tube, . 135 

39. London Supporter, 143 

40. Elastic Abdominal Bandage, 144 

41. Leiter's Tube-cap, 149 

42. Rubber Water-coil, 151 

43. Cradle for Supporting Bedclothes, . 156 

44. The External Genitalia, 169 

45. Cavity of the Uterus and Fallopian Tubes, 171 

46. Equipoise Waist, „ 178 

47. Fountain Syringe, 191 

48. Rubber Bed pan, 194 

49. Utero- vaginal Irrigator, 195 

50. Vaginal Nozzle with Reverse Current, ........ 196 



ILLUSTRATIONS. XV 

FIG. PAGE 

51. Chadwick's Gynaecological Table, 204 

52. The Uterine Sound, 206 

53. Bi-valve Speculum, 206 

54. " Speculum, Virginal, ..... 207 

55. Cylindrical Speculum, 207 

56. Sims's Speculum, 208 

57. Dressing Forceps, 209 

58. Sims's Position, or Semi-prone Position, 212 

59. Genu pectoral Position, 213 

60. Operating Pad, 218 

61. Leg-holder, 227 

62. Dorsal, or Lithotomy Position, 228 

63. Anatomical Forceps, 240 

64. S-shaped Catheter, 245 

65. Bulbous Catheter, 246 

66. Paquelin's Thermo- cautery, . 250 

67. Aspirator and Needle, 254 

68. Intra-uterine Return Catheter, . 255 

69. Bistouries, 261 

70. Diagram of Nurse Report, f 267 



" So kind, so duteous, diligent, 
So tender over (her) occasions, true, 
So feat, so nurse-like ! " 

Shakespeare's Cymbeline, iv, 5. 

' Ask God to give thee skill in comfort's art 
That thou mayst consecrated be and set apart 
Unto a life of sympathy; 

For heavy is the weight of woe in every heart, 
And comforters are needed much of Christ-like touch." 

Unknown. 



NURSING 

IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 



CHAPTER I. 

THE SURGICAL NURSE. 



"A perfect nurse," says the surgeon, J. Grieg Q Ualific 

tioi 

' nursing. 



Smith, in his celebrated work on Abdominal Sur- tlc 



gery, " is a perfect woman, rarely to be had." There 
are possibilities of perfection, however, in every 
human being of average health and ability. Both 
men and women fail oftener in attaining a high 
degree of excellence in character and work from 
indolence rather than incompetency. 

" Energy of will — self-originating force — is the 
soul of every great character. Where it is, there is 
life ; where it is not, there is faintness, helplessness, 
and despondency." Energy of will is largely a 

17 ' 



15 NURSING IN ABDOMINAL SURGERY. 

matter of self-discipline, and it is one of the first 
requisites to success in nursing as in other pro- 
fessions. 

A serene, sunny disposition is another important 
qualification in a good nurse, for it serves to pro- 
duce an atmosphere of quiet content in the sick- 
room which conduces greatly to the comfort and 
well-being of the patient, as of all concerned. 

Self-forgetfulness, sympathy, cheerfulness, pa- 
tience, tact, quickness of observation, method and 
skill in action, implicit obedience and loyalty to her 
physician — all of which are so essential to the good 
nurse — are the fruit of long and careful self-disci- 
pline combined with practical experience. 
for C train- y The surgical nurse should be habituated to the 
m§ * sight of blood. She should be strong-nerved and 

of steady hand. Sudden emergencies should not 
throw her off her guard. Thorough training and 
a knowledge of the conditions which may demand 
prompt action on her part will enable her to attain 
the necessary self-possession. Knowledge gives 
courage. Skill is gained by practice. For the 
acquirement of knowledge and skill it is essential 
that the surgical nurse should have a course of 
training in the wards of a hospital where consid- 
erable surgical w 7 ork is done. 

So much does the success of a surgeon's work 
depend upon the nurse that extreme care should 



THE SURGICAL NURSE. 1 9 

be exercised in the selection of a suitable person 
to undertake the supervision and after-care of an 
operative case. 

It is to be hoped that the training-schools of our 
country wilL greatly increase the number of nurses 
fitted to assume these important trusts. 

Personal cleanliness is essential in every nurse. 
This does not imply a simple adherence to the 
ordinary rules for bathing and general care of the 
person. " Surgical cleanliness aims at the removal ckaSlnLs 
of microscopic particles," hence requires a thorough 
appreciation of the principles of asepsis and anti- 
sepsis. The danger of a nurse's carrying disease 
from one patient to another makes it imperative 
that her entire body, including her hair, should 
receive a thorough cleansing between the different 
cases she may nurse. After the general bath of 
warm water and soap, the surface of the body 
should be washed with an antiseptic solution ; as, 
corrosive sublimate (1-1000); Labarraque's solu- 
tion of chlorinated soda (1 part to 8 of water); 
or carbolic solution (1-40). The chlorinated soda 
solution should not be used on the hair, because 
of its bleaching effect. The irritation of the skin 
produced by any of the antiseptic washes may be 
prevented by a subsequent plunge or sponge bath 
of simple warm water 

The costume of a nurse is another matter of »°~" me of 



20 NURSING IN ABDOMINAL SURGERY. 

great importance. Apart from its being neat and 
clean, the entire costume should consist of wash 
materials, to insure its being free from contagion. 
Without previous washing no articles of dress 
should be worn in attendance upon two different 
cases 
Disinfection Clothing worn at a contagious case should be 

of clothing. & «> 

allowed to soak in an antiseptic solution from one to 
two hours before its subjection to the ordinary pro- 
cesses of the wash. 

Care should be taken to rinse out the antiseptic 
solutions very thoroughly before boiling the cloth- 
ing, as the chemical agents ordinarily used might 
otherwise produce discoloration. Corrosive subli- 
mate (i-iooo) and carbolic solution (1-20) are the 
agents usually employed. A preparation which 
has been satisfactorily employed in many hospitals 
for washing infected clothing is the following : Four 
ounces of sulphate of zinc, and two ounces com- 
mon salt dissolved in 1 gallon of water. The 
clothing may be boiled in this for half an hour and 
lie in the solution from 4 to 5 hours. 

The bleaching effect of chlorine prevents the use 
of this for colored clothing. Boiling the clothing 
for half an hour would cause its thorough disin- 
fection, but as care should be taken not to subject 
those who attend to the washing to danger from 
infection, and since many laundresses cannot be 



THE SURGICAL NURSE. 21 

trusted to boil the clothing, it is a safe plan to sub- 
ject it to this double process of cleansing. The 
methods of disinfection for various articles will be 
more thoroughly dwelt upon in another chapter. 
I touch upon the matter here in order to impress 
the nurse with the fact that a thorough disinfection 
of herself is as important as that of her patient and 
his surroundings. 

During an operation the nurse should wear an fo^pera- " 
entirely fresh suit of clothing, and, if she is obliged 1C 
to handle sponges or so assist the surgeon as to 
come in contact w 7 ith him or the patient, a large 
clean apron and fresh slip-sleeves should be put on 
after all things else are in readiness for the operation. 
The especial precautions to be taken in the prepa- 
ration of her hands for her work are as follows : — 

The nails should be kept closely cut, the hands ^ a care g of 
smooth and soft, that they may not feel rough to hands * 
the patient as they come in contact with his skin. 
Cold cream or a little glycerine rubbed over the 
hands at night ; or, if the skin be irritated by pure 
glycerine, the use of a wash consisting of bay-rum 
(^) and glycerine {}/{), makes a nice lotion for the 
hands. 

Work properly done need not spoil the hands, 
provided the precaution be taken after washing 
them to dry them thoroughly, and to anoint them 
as suggested, when rough. 



22 NURSING IN ABDOMINAL SURGERY. 

Should the nurse's hands come in contact with 
foul discharges, a first cleansing with soap and cold 
water will best help to remove the odor. Warm 
water with soap may then be used w T ith a nail-brush 
for more thorough removal of all particles of dirt, 
and then some antiseptic, as chlorinated soda. In 
the special cleansing of the hands for surgical 
work, various methods may be followed. Thus 
after a thorough cleaning with soap and water for 
several minutes, the nail-brush being carefully 
used, the hands may be immersed in an antiseptic 
wash, which is similarly, thoroughly applied by 
means of a nail-brush around the finger-nails, etc. 
Pure alcohol may be used, or corrosive sublimate 
solution 1-1000, or Labarraque's solution 1-8. 

A method employed in some hospitals for steril- 
izing the hands is described as follows : Ten 
minutes are spent in washing the hands, finger- 
nails, and fore-arms with brown (oleine) soap and 
warm water and a moderately stiff scrubbing brush. 
After washing thoroughly in water and soap, the 
hands are next immersed in a saturated solution of 
permanganate of potash, and held there until they 
are uniformly deeply stained ; from this they are 
transferred to a saturated solution of oxalic acid, 
which removes the stain in one minute. They are 
then dipped in plain water, then in alcohol, and 



THE SURGICAL NURSE. 23 

finally laid in a bath of bichloride of mercury 
(1-1000) for a full minute.* 

A nurse should keep her breath sweet. The£ are ° f 

r breath. 

existence of a bad catarrh will incapacitate her 
for surgical nursing. The mouth and teeth and 
the digestive organs should also receive the atten- 
tion they demand, so that the patient may suffer 
no annoyance from their effect upon the breath. 

It should not be necessary to remind a nurse of Personal 

• r • 1 1 1 1 a hygiene. 

the importance of attention to her own health. An 
earnest purpose to attain the highest success in her 
work should lead every nurse to so dispose of her 
hours of leisure as to keep herself in the best 
working order. " This one thing I do/' should be 
her motto ; and food and drink, clothing, rest, and 
recreation should be so adjusted as to train her for 
active duty, and for the strain which must often 
come to her in the long vigils of the sick-room, 
when every sense should be acute to discover the 
slightest change in the sufferer, and every faculty 
fully alive to the demands of the moment. Acute 
conditions demanding the almost constant presence Sole man- 

A agement 

of the nurse seldom last longer than a few days, desirable - 
and a well-trained nurse can ordinarily bear the 
strain very well for that length of time. Should the 
critical condition be protracted, it may be necessary 

* Dr. H. Kelly. 



24 NURSING IN ABDOMINAL SURGERY, 

to have a division of labor by association with 
another nurse. 

It is so much more satisfactory for one nurse to 
manage a case throughout, that, unless it is im- 
perative, such an arrangement for sharing work 
should be avoided. The assistance of some reliable 
member of the family, at times when the patient is 
not requiring very especial attention, will often 
permit a most trying case to be carried through 
with but one nurse's supervision. 

The simplest and most wholesome food and 
drink, regular out-door exercise, sufficient sleep at 
a time when sleep is legitimate, good sense in the 
matter of dress, occasional change of scene and 
thought in the intervals between cases, will help to 
keep a nurse in good condition for duty. 

" What is there in the world to distinguish 
virtues from dishonor, or that can make anything 
rewardable, but the labor and the danger, the pain 
and the difficulty ? " — Jeremy Taylor. 



CHAPTER II. 

THE GERM THEORY OF DISEASE. 

In order to thoroughly understand the import- 
ance of the minute details to be observed in sur- 
gical nursing, it is essential that the nurse should 
know something of the researches of modern 
science which have developed w 7 hat is called the 
" germ theory of disease." 

" Germs " or " bacteria" are forms of vegetable description 

23 oi germs. 

life so minute as to be singly invisible to the naked 
eye. Numerous forms of bacteria have, however, 
been carefully examined and studied through the 
microscope, and scientists have thus in recent years 
learned much of their nature and activities. These 
researches have proved a most valuable contri- 

« i • r i- • r i ii Value of 

bution to the science of medicine, for through them scientific 
it has been found that many of the most deadly 
processes of disease are due to the irritating pres- 
ence of special germs and to the changes which 
they bring about in the human body. 

The causation of disease as induced by these 
minute organisms, and its prevention by suitable 
management, are subjects of such great import- 

25 



26 



NURSING IN ABDOMINAL SURGERY. 



Diseases 
and dis- 
eased con- 
ditions due 
to germs. 



Properties 
of bacteria. 



ance that scientific workers all over the world are 
devoting time to the study of bacteria, with the 
hope of eventually exterminating some of the 
present most fatal maladies. Thus consumption, 
typhoid fever, cholera, diphtheria, and pneumonia 
are due to germs, each disease having its own 
specific cause. The same may be said of surgical 
diseases, — the complications which may arise in the 
healing of wounds ; as, inflammations, abscesses, 
erysipelas and the various forms of blood-poison- 
ing. 

Bacteria exist almost everywhere. They have 
the power of nourishing themselves by using certain 
portions of dead organic material, leaving the rest 
in such form as to be used by other living things. 
They also have the power of moving and of repro- 
Conditions ducing their kind. Warmth, moisture, and a cer- 

necessary to 

development tain amount of organic matter, are the conditions 

of germs. % ° 

which favor their development. Most, but by no 
means all, forms of bacteria require air; some, how- 
ever, can develop only in the absence of air. 
Sc?eal?° f Where the conditions are favorable they may 
increase with great rapidity. The process of repro- 
duction is as follows : One of the bacteria grows 
a little longer, a constriction forms about the middle 
which finally becomes a complete partition, so that 
Method of two distinct individuals are thus formed. These 
reproduc- s i m ilarly divide to produce other bacteria, and their. 



THE GERM THEORY OF DISEASE. 2J 

number thus multiplies. These separate bacteria 
may fall apart or cling together in chains or in 
masses. Other forms of these organisms grow by 
spore-formation. A central spot, or spore, forms 
within the rod. The rod opens and the spore 
drops out and subsequently develops and propa- 
gates its kind. The figures giving us the estimate 
of the rapidity with which they reproduce them- 
selves, seem almost fabulous. Thus it has been 
authentically stated that a single germ by this 
process of growth may in twenty-four hours give 
rise to more than sixteen and a-half millions. 

Bacteria are of various shapes ; the most frequent Forms un- 

• L * > der which 

are the round, oval-shaped, rod-shaped, or spiral- bacteria 
shaped. To give an idea of their size it has been 
said that of one of the most common forms of 
bacteria (a little rod), were fifteen hundred of them 
put end to end, they would scarcely reach across 
the head of an ordinary pin. 

The different species of bacteria are very numer- Species. 
ous. These organisms are to be found wherever 

- r i • r • • Substances 

any form of hie can exist — in water, in the atmo- and locaii- 

• i m • r i i • i «ii ties in which 

sphere, in the soil, in our food and drink, especially found. 
that which is uncooked; in all the orifices and 
canals of our own bodies which communicate with 
the air, wherever dust can go or collect, there are 
bacteria of various forms in greater or smaller 
numbers. 



28 



NURSING IN ABDOMINAL SURGERY. 



Condition 
in which 
inactive. 



Species 
that infect 
wounds. 



Streptococ- 
cus. 



Staphylo- 
coccus. 



Method of 
infection. 



" Pto- 
maines.' 



When the bacteria are dry they are said to be 
inactive, as they are not capable of increasing and 
multiplying as they do where moisture and the 
special food they need is present. Of the special 
forms of bacteria which are apt to infect wounds, 
it has been found that there are two particular 
species which give the most trouble in the majority 
of cases. These are round in shape and are called 
" micrococci." One species in growing forms 
chains and is called Streptococcus, the other forms 
clusters like bunches of grapes and is called 
Staphylococcus. 

Both these forms of bacteria exist very abun- 
dantly in dirty places, even where healthy people 
live, but especially where the sick are crowded 
together. Therefore they are especially to be 
guarded against in hospitals. 

They are found floating in the air or resting with 
the dust upon any surface exposed to the air. 
When dust falls upon the open surface of a wound, 
or any object upon which bacteria rest comes in 
contact with such a surface, these living organisms 
lodge in the wound, and if not destroyed grow 
there, forming poisonous materials called " pto- 
maines," which interfere with the proper healing of 
the wound. Poisonous materials may even thus 
gain access to the blood and be carried to distant 
parts of the body, where they continue to develop. 



Uses of 

teria in 
nature. 



THE GERM THEORY OF DISEASE. 29 

The whole system may then become infected with 
the poison, causing serious and often fatal results. 

In the occurrence of inflammatory complications Pyogenic 

y x bacteria. 

in the healing of wounds, pus in greater or less 
quantity is apt to be produced. For this reason 
the bacteria causing such complications are called 
pits-forming or pyogenic bacteria. 

This representation of the irritating nature of 
bacteria under especial conditions is not intended 
to convey the idea that they are entirely destructive 
in their tendency. Like all things else in nature,^ 
they have a special purpose to serve. They break 
or tear up worn-out material and thus get it in 
readiness for new uses — much as a pair of scissors 
will rip up an old garment and get it in readiness for 
re-fashioning. Only the bacteria, unlike the scissors, 
accomplish this work of separating the particles of 
matter by appropriating to themselves certain sub- 
stances which serve for their own nutrition. 

It is only when the condition of the body, or any 
part of the body, is such as to favor the rapid mul- 
tiplication of these germs that diseased conditions 
may be induced. 

If the standard of health is maintained by due security 
attention to physiological and sanitary principles, dfstTuctive ir 
even those liable by heredity to special forms of 
disease may do much to resist the deleterious 
effects induced by the presence of germs. 



30 NURSING IN ABDOMINAL SURGERY. 

Hygienic We would, therefore, in this connection remind 
' the nurse of the subtle influences of sunlight, fresh 
air, good food, cleanliness, and cheerfulness, which 
will enable her, in the care of the severest cases of 
illness, to successfully meet and resist the attacks 
of the unseen but ubiquitous foe. 



CHAPTER III. 

ASEPSIS AND ANTISEPSIS. 
The word " clean " is derived from an old Saxon Definition 

. of terms. 

term, " claene," which signifies " to open, to remove, 
to separate." The term " cleanliness," therefore, 
implies a condition of absolute freedom from all 
extraneous or foreign matter. 

Surgical cleanliness refers more particularly to 
the absence of all germs of putrefactive change. 

The words " aseptic " and " antiseptic," so con- 
stantly used by the surgeons of the day, come from 
a Greek root, the word " septos," meaning " putrid." 
Asepsis means literally " without putrefaction." 
The germs of putrefactive change may never have 
been present, or if once present, should have been 
entirely destroyed in any object which is termed 
" aseptic." 

Antisepsis means " against sepsis or putrefaction," 
and comprises the means or methods ' by which 
objects may be rendered " aseptic." Any sub- 
stance in which all germs have been destroyed by 
antiseptic measures, is said to be "sterilized" because 
the germs have been rendered incapable of doing 

31 



32 NURSING IN ABDOMINAL SURGERY. 

further injury by continued reproduction. The 
application of a high degree of heat — dry or moist 
— and the use of certain chemical agents constitute 
the measures by which germs may be rendered 
harmless. 
steriiiza- In sterilizing 1 inanimate things heat is generally 

tionofin- *> & > ^ J 

struments, employed. Instruments, towels, clothing, etc., may 

towels, etc. r J ' ' & ' # ' J 

thus be sterilized by either dry or moist heat. 
In the use of dry heat it is essential to attain 
a temperature considerably above the boiling 
point of water, — at least 230 Fahr. (uo° C). 
In the disinfection of articles supposed to contain 
spores (the seeds or eggs of bacteria) it is well 
to employ this degree of heat for two hours. 
Furnaces or ovens of special design are employed 
steriiTza- for sterilization by this means, as also for the use 
of steam under pressure. In the latter case the 
temperature should be raised to 22 1 ° Fahr. (105 ° C). 
For office or hospital work instruments must be 
kept constantly ready for use, and a small sheet- 
office oven, iron oven, heated by gas, such as is used for 
bacteriological work, may be employed. This is 
provided with a thermometer and with a thermostat, 
by which the flow of gas is automatically controlled, 
so that the heat is maintained within known limits. 
The instruments should be subjected to this heat for 
about one hour. With steam, which is more pene- 
trating than dry heat, ten to fifteen minutes is 



ASEPSIS AND ANTISEPSIS. 



33 



sufficient for purposes of sterilization. It is not 
uncommon, however, for greater security, to leave 
the articles in the steamer longer, as for an hour. 



Fig. i. 




Sterilizing Oven. 



Boiling in water for the same length of time is 
also sufficient, unless the article be bulky, when it 
is well to extend the time to a half hour. The 



34 NURSING IN ABDOMINAL SURGERY. 

Arnold Arnold steam sterilizer is perhaps the most con- 

steam . ...... 

sterilizer. ' venieiit arrangement for the sterilization of instru- 
ments, towels, etc., and is in use now in most 
hospitals. It consists of a pan, which contains the 
water to be heated, communicating with a closed 
chamber in which the steam accumulates. The 
articles to be sterilized are placed in this chamber. 
A double lid is arranged for the prevention of escape 
of steam. (See Fig. 9.) 

sterilization Water itself is rendered aseptic by filtering and 

of water. , ... .. .... - , ... __^ . ... . 

Doiling, or distilling and boiling. Distilled water 
should be entirely aseptic, but its manufacturers 
rarely appreciate the minute details of asepsis suf- 
ficiently to take proper precautions to prevent con- 
tamination. Hence, even w T hen distilled water is 
employed for an operation, it is well for the nurse 
to take the precaution of boiling it in vessels which 
she knows to be clean. Water thus sterilized is 
made fit for contact with open wounds. Neither 
rain water nor melted ice will serve as a substitute 
for water thus prepared, as they are not free from 
germs. 

In the many cases in which heat cannot be used, as 

in the sterilization of living tissues, chemical agents 

are employed in solutions of suitable strength, or 

in the form of powder. The agents thus used are 

Antiseptics, termed " antiseptics/' and may be employed accord- 



ASEPSIS AND ANTISEPSIS. 35 

ing to their properties and the strength of their 
solutions, for one of two purposes, — either as 
" germicides," true germ-killers, or as " inhibitory 
agents," that is as substances which check the 
activity of germs and thus prevent their injurious 
action. True germicides are so poisonous that they 
cannot be used except in very dilute solutions 
when brought in contact with living tissues. In 
fact, even dilute solutions have been known to 
cause poisoning by absorption ; hence more and 
more in wound surgery the use of boiled distilled deep-wound 

•1 1 r-\ 1 • 1 1 surgery. 

water, or boiled filtered water, is replacing the 
use of antiseptic solutions. Especially is this the 
case in the surgery of the internal organs. The 
use of antiseptic washes is more frequent in the 

'11 Antisepsis 

treatment of surface wounds, accompanied by a in surface 

wounds. 

foul discharge. 

Antiseptic agents in sufficient strength to be 
germicidal are, therefore, only used for the destruc- 
tion of germs in putrescent substances outside the Germicides. 
body. Thus, typhoid stools, diphtheritic discharges, 
etc., should be rendered innocuous by the strongest 
germicides available. Such use should be kept 
entirely distinct from their application in wound 
surgery. 

The following list gives those most commonly 
employed for germicidal effect. 



matter. 



36 NURSING IN ABDOMINAL SURGERY. 

I. Chloride of lime solution, 4 per cent., made by 

adding 6 ounces to the gallon of water. 
II. Bichloride of mercury (corrosive sublimate) 
solution 1-500, that is 15 grains to the pint. 

The above are the best chemical solutions to 
employ for the disinfection of spore-containing 
material. 

Disinfection (a) Chloride of lime in powder is a good disinfect- 

of waste • 1 * • 

organic ant for sprinkling' over masses of organic 

mot «•*»»• r 1=3 e> 

material in privy vaults, etc. It has been 
estimated that about one pound of chloride 
of lime is required for every thirty pounds of 
such material. Should corrosive sublimate 
be used for the purpose, one pound of the 
powder for every* five hundred pounds of 
faecal matter will be sufficient. 

(J?) Slaked lime in the proportion of about one per 
cent., that is one pound to the hundred of 
the material to be treated, has been shown 
recently to be an efficient germicide. 

(c) Copperas (sulphate of iron), or green vitriol, in 
the proportion of \]/ 2 pounds to a gallon of 
water, is a valuable agent for the arrest of 
putrefactive decomposition, being readily 
available because of its low price. 

These substances are all of great value where it 
is impossible to remove filth from the vicinity of 



ASEPSIS AND ANTISEPSIS. 37 

houses, but they are a poor substitute for cleanli- 
ness. 

For the disinfection of discharges in the sick- Disinfection 

of sick-room 

room, the solutions ordinarily employed are — discharges. 

I. Corrosive sublimate (1-500), 15 grains to the 

pint of water. 
II. Chloride of lin\e (4 per cent.), 5 drachms to the 
pint. 

III. Carbolic acid (5 per cent.), about ^ of an 

ounce to the pint. 

IV. Sulphate of copper (5 per cent.), about ^ of 

an ounce to the pint. 

Underclothing, bedding, etc., if infected, are best Disinfection 
destroyed by fire, if of little value. clothing, 

. ■ t bedding, 

To disinfect them, we may employ — etc. 

(a) Boiling for at least a half hour. 

(&) Boiling for half an hour in a solution of 4 

ounces sulphate of zinc, 2 ounces common 

salt, to 1 gallon of water. 

(c) Immersion for three or four hours in a solution 

of corrosive sublimate, 1-1000. 

(d) Immersion in a 5 per cent, carbolic solution 

for the same length of time. 
To avoid the discoloring effects of these solu- 
tions, clothing taken from them should be thor- 
oughly rinsed out in clear water before it is sent 
to the laundry. 



38 NURSING IN ABDOMINAL SURGERY. 

Outer garments, which would be injured by boil- 
ing water or a disinfecting solution, may be steril- 
ized — 

(a) By exposure to dry heat at a temperature of 

230 Fahr. (uo° C). 
(p) By the steaming process in a suitable apparatus. 

Mattresses and blankets should be disinfected in 
the same way. If these means are not available, 
mattresses may have their covering removed, and 
washed and boiled separately, the contents being 
immersed in boiling water for a half hour. 
tiinoffuV Furniture, floors, zvood-zvork, painted walls, etc. of 
mture,etc. a room should be washed with either — 

(a) Corrosive sublimate solution (1-1000), which 

is most efficient, or — 
(J?) Carbolic acid solution 2 per cent. 

Disinfec- Rooms are generally disinfected by burning sul- 

tionofa ,.,-•'. r i ' x r 

room. phur in the proportion of at least 3 pounds for 
every thousand cubic feet of air space. To secure 
any good results close the apartment as closely as 
possible by stopping up all apertures through 
which the gas might escape, by means of wet rags, 
which may be stuffed into the cracks around doors, 
windows, etc. The sulphur is put into a deep tin 
pan which is placed upon two bricks, in a tub 
partly filled with water, in the middle of the room. 



ion 
per- 



ASEPSIS AND ANTISEPSIS. 39 

A little alcohol may be poured on the sulphur, 
which is then set on fire, or a few live coals placed 
in the pan. The fumes should be kept in the 
apartment from twelve to twenty-four hours, after 
which doors and windows should be thrown open, 
and it should be subjected to free ventilation. All 
surfaces in the room are then washed off with one 
of the above-mentioned solutions. 

For the disinfection of the sitrface of the body, Disinfect 

J J "of the pe 

after a thorough wash with soap and warm water, son 
use may be made of — 

I. Absolute alcohol, as in cleansing the hands 
(too expensive for general use). 
II. Solution of corrosive sublimate, i-iooo. 

III. Solution of chlorinated soda, i-io. 

IV. Carbolic acid solution, two per cent. 
V. Saturated solution of permanganate of potas- 
sium, followed by the saturated solution of 
oxalid acid. This should be used for the 
hands alone, according to the method de- 
scribed in the chapter on the Surgical 
Nurse. 



Open wounds or raw surfaces are cleansed pre- cleansing 
ferably with boiled distilled water. When dirt has wounds. 
entered the wound, or pus has formed, showing the 
presence of germs, we may use — 



4Q 



NURSING IN ABDOMINAL SURGERY. 



Surgical 

dressings. 



Prepara- 
tion of 
bichloride 
gauze. 



I. Solution of corrosive sublimate, 1-4000, I- 

5000, etc. 
II. Carbolic solution, 2 per cent. 
III. Beta-naphthol solution, 1-2500. 

A preparation used much of late for pus-secret- 
ing cavities and surfaces, is peroxide of hydrogen 
(hydrogen dioxide), which has no equal either for 
safety or efficiency. The compound is so unstable 
that, unless the bottle containing it be kept very 
firmly and securely corked, in the intervals of its 
use, it will lose its virtue. It should' always be 
kept in a dark, cool place, and should not be shaken 
violently. 

For surgical dressings we do not so much need 
germicides as inhibitory agents. The various 
gauzes as ordinarily prepared with bichloride of 
mercury, boric acid, carbolic acid, eucalyptus, sali- 
cylic acid, etc., serve this purpose, as does the use 
of iodoform, aristol, or boric acid in powder. 

Bichloride of mercury, or corrosive sublimate 
gauze, is that most generally preferred. To pre- 
pare it the gauze is allowed to soak for an hour in 
a sud of soft soap, to remove all " sizing." It is 
then wrung out of clear water several times until 
the soap is well out of it, and is immersed in a 
solution of corrosive sublimate, 1-100(75 grains to 
the pint of water), or a weaker solution, as 1-1000, 
may be used. It is then dried in an oven. As 



ASEPSIS AND ANTISEPSIS. 4 1 

drying the gauze in this way, especially if the 
temperature of the oven be raised high enough to 
bake it, has the effect of rendering it non-absorbent, 
it is desirable either to sprinkle a little glycerine 
over the layers of gauze before drying,' or to put a 
small quantity in the corrosive sublimate solution 
used in its preparation. After this process the 
gauze should be kept carefully from dust and con- 
tamination by contact with unsterilized substances. 
It may be rolled in an antiseptic towel for this pur- 
pose, and kept in a closed box or drawer. 

After surgical instruments have been rendered protection 
aseptic by thorough cleansing with soap and water, instruments 
followed by the process of baking, steaming, orerations. 
boiling, they may be kept free from contamination 
during an operation by lying immersed under — 

I. Sterilized water. 
II. Beta-naphthol solution, 1-2500. 
III. Carbolic acid solution, 2 per cent, or 1-40. 

The blackening effect of carbolic acid may be 
prevented by the addition of a little glycerine to 
the solution. 

The use of iodide of mercury as an antiseptic — 
a substance used in the same manner as corrosive 
sublimate — need scarcely be mentioned. The solu- 
tions are more troublesome to prepare, and no more 



42 NURSING IN ABDOMINAL SURGERY. 

efficient, hence their use is limited. Various other 
substances have been used for antiseptic purposes, 
but those mentioned here are the most frequently 
and universally employed. 

In the preparations of solutions of corrosive sub- 
limate, chlorinated lime, and copperas, it should be 
remembered that they have an injurious effect upon 
metal, hence should be mixed in glass, porcelain, 
or agate vessels. Large quantities of solution of 
chlorinated lime may be made in a bucket. 
Relations These rules concerning the use of antiseptics 
asepsis and should be thoroughly understood by every good 

antisepsis. 

nurse, for even the surgeons who employ aseptic 
methods, as a rule, require the use of antiseptics 
beforehand, to bring about a perfect state of asepsis 
for the operation, and to enable the aseptic state to 
be preserved after the operation. 

RULES FOR MAKING UP SOLUTIONS. 

To prepare solutions of «a certain percentage of 
strength, the following rule is sufficiently accurate 
to serve as a guide for work : — 

Reduce the quantity of the solution desired to 
minims and then multiply the same by the decimal 
figures representing the percentage desired. The 
result will give the quantity (in minims) of the 
chemical to be employed in making the solution. 



ASEPSIS AND ANTISEPSIS. 43 

This number may be changed to a higher denom- 
ination, if desired, by dividing by 60, which will 
give the number in drachms. 

The following method of making up I pint of a 
2 per cent, solution of carbolic acid will serve as an 
illustration : — 

1 pt. = 7680 m. 

7680 m. X .02 = 153.60 m., representing the 
amount of carbolic acid. 

153.60 m. -r- 60 m. = 2.56, or about 2^/ 2 drachms. 

(With ordinary chemicals, 1 gr. is considered 
equivalent to I m.). 

The accurate compounding of a solution would 
require both the weight of the solvent and the 
chemical to be ascertained, but this must be done 
by the apothecary, and is essential only where 
very active preparations are employed. 

A 1 per cent, solution means one part in the 
hundred. I drachm of deliquescent carbolic acid 
to 99 drachms of water, therefore, makes a I per 
cent, solution of carbolic acid. 

A 2 per cent, solution of carbolic acid would 
represent j^-, or -^ of the amount as represented 
by the carbolic acid. This would give us the pro- 
portion as 1-50. A quick way of making up a 
quantity of this solution, would be to take 1 ounce 
by measure of the deliquescent carbolic acid to 49 



44 NURSING IN ABDOMINAL SURGERY. 

ounces of water, or I drachm to 49 drachms of 
water. 

A 5 per cent, solution would equal 1-20. A gill 
measure and a medicine glass will enable a nurse 
to make up quickly the solution desired, provided 
she has a sufficiently accurate knowledge of arith- 
metic to work out the necessary problems. In 
making up solutions of bichloride of mercury, which 
is an exceedingly poisonous substance, it must be 
remembered that 7^ grs. by weight to 1 pint of 
water will give us the strength of 1-1000. With 
this solution as a base, the weaker solutions may 
be made by adding the requisite amount of water. 



CHAPTER IV. 

ABDOMINAL SECTION. 

The operation of abdominal section consists in Definition. 
the making of an incision through the walls of the 
abdomen, by which the surgeon is enabled to per- 
form any operation required upon the organs con- 
tained in the abdomen or the pelvis. 



Abdominal 
organs. 



The abdominal organs are : — 
The stomach. 
The intestines. 
The liver and gall-bladder. 
The kidneys and ureters. 
The spleen. 
The pancreas. 

The pelvic organs are : — Pelvic or- 

The uterus, or womb. 
The Fallopian tubes. 
The ovaries. 
The bladder. 
The rectum. 

All these organs are subject to disease, to inju-C a " ses . f °r 

° J ' J abdominal 

ries the result of accidents, and to the development section - 

45 



46 



NURSING IN ABDOMINAL SURGERY. 



of new growths termed " tumors." Hence it may 
be seen that an abdominal section may be under- 



FlG. 2. 




Diagram Showing Abdominal Organs. 



ABDOMINAL SECTION. 



47 



taken for very varied conditions. Where no actual 
disease exists, as in pregnancy, when the birth- 
track is too small, or there is some other abnormal 



Fig. 3. 




Cut Showing Vertical Section of Pelvic Organs. 

condition preventing the occurrence of labor in the 
natural way, abdominal operation may be per- 
formed to effect the act of delivery. 



48 NURSING IN ABDOMINAL SURGERY. 

The special operation required in each case is 
known by a distinctive name. Since the nurse's 
work is closely associated with that of the surgeon, 
she will constantly hear these terms used. It is 
desirable that she should understand their meaning 
(although it is not necessary, or even in good taste, 
for her to attempt their use), in order that she may 
make the necessary preparations in any given case 
intelligently. For the better understanding of 
these terms I append a list of the principal abdo- 
minal operations : — 

Operations Operations on the Ovaries and Fallopian Tubes : — 

on internal L *■ 

genital t /^v • -\ r • 

organs. 1. Ovariotomy — removal of ovarian tumors. 

II. Oophorectomy — removal of ovaries of com- 
paratively small size, diseased or healthy. 
III. Removal of uterine appendages, when the 
tubes and ovaries are both removed. 

Operations on the Uterus : — 

I. Hysterectomy — removal of the uterus. 
II. Csesarean section — an incision into the 
uterus during pregnancy, for extraction of 
the child. 

III. Porro's operation — removal of the uterus, 

added to Csesarean section. 

IV. Operation for extra-uterine pregnancy — re- 

moval of tumor composing the ovum or egg, 



ABDOMINAL SECTION. 49 

when it is found outside of the uterine 
cavity. 
V. Abdominal section for rupture of the uterus. 

Operations on the Stomach and Intestines : — ° P the tions 

x •-» • . . stomach. 

I. Gastrotomy — the making of an incision into 
the stomach for the removal of foreign 
bodies. 
II. Gastrostomy — the establishing of a tube-like 
passage into the stomach. 

III. Gastrorraphy — the suturing of wounds in 

the stomach. 

IV. Pylorectomy — removal of a part or the whole 

of the pylorus. 
V. Gastro-enterostomy — the formation of a pas- 
sage between the stomach and duodenum. 
VI. Duodenostomy — the operation of opening the Operations 
duodenum, and attaching it to the abdom- tmes. 
inal wall to form an orifice for the intro- 
duction of food. 
VII. Jejunostomy — the making of an artificial 
opening through the abdominal wall into 
the jejunum, for introduction of food. 
VIII. Operation for intestinal obstruction. 
IX. Enterotomy — the making of an opening into 
the intestine. 
X. Colotomy — the making of an incision into 
the colon. 



50 NURSING IN ABDOMINAL SURGERY. 

XL Resection of intestine — the removal of a 

portion of intestine. 
XII. Operation for artificial anus. 

Operations Operations on Kidneys : — 

on kidneys. r J 

I. Nephrorrhaphy — the suturing of the kidney 

to the abdominal wall. 
II. Nephro-lithotomy — the operation for removal 
of stone in the kidney. 

III. Puncture of the kidney. 

IV. Nephrotomy — an operation for opening into 

the substance of the kidney. 
V. Nephrectomy — removal of the kidney. 

o^ii^r 0115 Operations on the Liver and Gall-Bladder :— 
bladder. I. Hepatotomy — an operation for opening into 

the liver. 
II. Cholecystotomy — an operation for opening 

into the gall-bladder. 

III. Entero - cholecystotomy — an operation in 

which, after opening into the gall-bladder 
and intestines, the two wounds are sutured 
to each other. 

IV. Cholecystectomy — removal of the gall-blad- 

der. 

?n P s r tee°n ns Operations on the Spleen : — 

Splenectomy — removal of the spleen. 



ABDOMINAL SECTION. 5 I 

Operations on the Pancreas :— ?n P panc«L. 

Operation for pancreatic cysts. 

Operations for Tumors of the Omentum. on omentum 

Operations for Tumors of the Mesentery. teV™ 6 

Cystotomy, or abdominal lithotomy — an operation Operations 

... ., . . 1t . on bladder. 

for an incision through the abdominal wall into 
the bladder. 

Although the operations mentioned are numer- 
ous, the general preparations for any case of ab- 
dominal section are so similar that they can be 
considered under one head. These will include 
the consideration of the following points : — 

I. Preparation of the room. 

II. Preparation of sponges, instruments and dress- 
ings. 

III. Preparation of the patient. 

IV. Preparation of the operator and assistants. 
V. A nurse's duty during operation. 

VI. A nurse's duty after operation and during 

convalescence. 
VII. The management of complications. 



CHAPTER V. 

THE PREPARATION OF THE ROOM. 

In speaking of the importance of obtaining for 
the patient the best possible surroundings for such 
an operation a celebrated English surgeon says : 
" There is no disputing the fact that the best results 
in abdominal surgery are got in specially prepared 
£g e room at ~ rooms or wards. * * * * An ideal room, situated 
in an open and elevated locality, ventilated with 
warmed (and perhaps filtered) air, wall and floor 
impermeable to moisture, and readily and easily 
washed, and with many other excellences which 
could be detailed — is rarely in this country at the 
disposal of surgeons." 

As a rule, the operation is done in the room 
which is to be occupied by the patient during the 
convalescence, unless in a special hospital where 
the rooms are conveniently arranged with reference 
to an operating room, and where suitable conven- 
iences exist for transferring patients from one room 
to another without too great risk. 

All the special preparations for aseptic work may 
be carefully arranged for, yet these cannot secure 

52 



THE PREPARATION OF THE ROOM. 53 

the results desired, should the operator, assistants, 
or nurses fail to observe the principles of surgical 
cleanliness in every detail. On the other hand, 
with a tliQrough understanding of these principles, 
operations of the gravest character may be per- 
formed with success in quarters the most unpromis- 
ing, and in the slums and alleys of a crowded city. 
Since " necessity knows no law," the surgical nurse 
must be prepared to convert even the filthy apart- 
ment of a tenement house into an aseptic operating 
room. To this end certain instructions regarding 
the preparation of the room should be observed. 

Dr. J. Grieg Smith tells us, " A well kept bed- 
room in a home of gentle folks will require nothing 
changed or removed." Should the surgeon in 
charge of a case assume the responsibility of this 
arrangement, the nurse will, of course, observe his 
wishes in the matter. Should the preparation of 

x l Cleansing of 

the room be left to her discretion, she should re- room - 
gard everything in the room with suspicion until 
she has placed it beyond suspicion in the matter of 
cleanliness. The room should, if possible, be large 
and bright, facing the south, and one which can be 
kept well ventilated and yet comfortably warmed. 
There should be no stationary wash-stand in the 
room. If impossible to obtain a room without, the 
basin should have all its outlets plugged, and be 
kept filled with some antiseptic solution. 



54 NURSING IN ABDOMINAL SURGERY. 

Removal of Carpets, curtains, upholstered furniture, every- 
fumiture. 115 thing that may harbor dust and filth, ought to be 
removed. If there is any possibility of the exist- 
ence of infectious or contagious germs in the room 
it should be subjected to thorough disinfection with 
the fumes of sulphur. Before the fumes are started 
the metal fixtures in the room should be well 
greased with cosmoline, to prevent the injurious 
action of sulphur upon them. After this the room 
should be well ventilated. Should an open fire- 
place or a stove be in the room, keeping the win- 
dows open for twenty-four hours or so, while a 
large fire is kept burning in the grate, will freshen 
and purify it. 
Use° f Regarding the use of the spray in purifying the 

atmosphere we' quote from Dr. Smith : * " Some 
surgeons seek to improve the purity of the atmo- 
sphere in which the operation is to be performed 
by making a steam antiseptic spray play in the 
room for a few hours. There is no strong objec- 
tion to this ; if it does nothing else it lays the dust. 
But if the room has been properly cleaned and 
ventilated, and the surrounding air is of the mod- 
erate purity and freshness that may be found almost 
anywhere in England, -the spray in the room is 
perhaps uncalled for. If any objection could be 

* "Abdominal Surgery." 



spray. 



THE PREPARATION OF THE ROOM. 55 

raised to the proceeding I think it ought to be on 
the ground of saturating the atmosphere with 
moisture. Respiration is not so easy in an atmo- 
sphere laden with moisture as in one that is dry, 
and if a patient has to undergo a prolonged and 
dangerous operation, we should desire to have the 
recovery from shock promoted by every possible 
surrounding benefit, one of which is certainly not 
a wet, depressing atmosphere to breathe." 

Should a surgeon desire this procedure carried 
out, it may be done as follows : A shallow basin 
filled with the antiseptic solution required may be 
placed over a gas stove, the steam from which will 
rise and fill the room. Doors and windows should 
be kept closed during the process of spraying until 
the whole apartment has been thoroughly filled 
with the steam. A special apparatus known as a 
"steam atomizer" is sometimes employed, and is 
essential where during the operation it is desired 
to have the spray directed over the wound. The 
nurse will need to keep the boiler filled about two- 
thirds full of water, to renew the antiseptic solu- 
tion in the bottle from time to time, and to keep 
the alcohol lamp in good working order. 

The walls, as well as the floor, should be well sterilization 

' ' of walls, 

swept, and all pictures removed. If painted it is floor > etc - 
well to wash the walls with a corrosive sublimate 
solution (i-iooo) or 2 per cent, carbolic acid. 



56 



NURSING IN ABDOMINAL SURGERY. 



The floor should be washed up with this solution 
after it has been well scrubbed. But little furniture 
should be permitted to remain in the room, but this, 
with the frames of windows, doors, etc., must be 
similarly washed off with an antiseptic solution. 
Shades must be taken down, dusted and then wiped 

Fig. 4. 




Steam Atomizer. 



Arrange- 
ment of 
furniture. 



off also with this solution. Strips of linen may be 
placed on the floor to deaden the footfalls. 

The furniture should be conveniently arranged. 
The bed should be so placed that access may be 
had to it upon three sides, for convenience in lifting 
the patient, changing bedding, etc. Also, it should 



THE PREPARATION OF THE ROOM. 57 

be so placed that the patient shall not face the light 
from the windows. It should be a single bed, 
preferably iron, and not too low, with a spring or 
woven-wire bottom, and a good horse-hair mattress. 
It is well, if possible, to have two beds, the patient 
being lifted from one bed to the other, every night 
and morning, and the bedding thus kept aired. 
This is not a necessity but a great comfort to the 
patient. A chair for the nurse and one for the 
doctor — not rockers — one or two stands, a wash- 
stand with china set, a bureau with a set of draw- 
ers, and one or two large screens, will constitute all 
that is necessary in the way of furniture. There 
should be a shade for the lamp, and a quiet-ticking 
clock placed where the nurse can see it without 
having to move too much about the room. Inside 
blinds are the best for tempering the light. There 
should, if possible, be a closet in the room, in which 
the various articles needed in the care of the 
patient may be kept. Changes of clothing, bed- 
ding, etc., may be kept in the bureau drawers. 

The clothing worn during: the operation and sub-ciothing of 

** . patient. 

sequent convalescence, should consist of woolen 
or merino vest, drawers, and socks, varying in 
thickness with the season, a night-dress of special 
pattern, extending just below the shoulders in the 
back, so as to avoid unnecessary and uncomfortable 
creasing of the clothing, as the patient lies upon 



58 



NURSING IN ABDOMINAL SURGERY. 



Steriliza- 
tion of 
clothing. 



Arrange- 
ment of 
bed-cloth- 
ing. 



her back ; the front pieces should extend down to 
about the knees. All the articles of dress should 
be a size larger, or even two sizes larger than those 
ordinarily worn by the patient, as they are more 
comfortable to lie in when loose. A Nightingale 
wrap of light flannel is a convenience for the pro- 
tection of the shoulders and arms. 

The preparation of the clothing, sheets, pillow 
cases, towels, napkins, etc., previous to operation is 
as follows : After coming from the laundry, where 
during the process of cleansing it should have been 
thoroughly boiled, it is wrung out of a solution of 
bichloride of mercury 1-1000, or carbolic acid, 2 per 
cent., when it is dried and smoothed with a warm, not 
hot, iron, or else left rough dry. Blankets should 
be either entirely new or they may be hung in a 
room or large closet, where carbolized steam is 
generated, as described above. 

Three sets of merino wear and night-dresses 
should be provided to permit the necessary chang- 
ing of clothing in case of accidents. During the 
operation it is well to have woolen stockings placed 
on the patient's feet. These are sometimes worn 
during the first week or ten days of convalescence. 

The bed clothing is adjusted as follows: Over 
the mattress is placed a pad for its protection, across 
the middle of the bed a piece of rubber cloth a yard 
and a-haif wide, pinned down securely to the edges 



THE PREPARATION OF THE ROOM. 59 

of the mattress. The under sheet or a blanket is 
then spread over the entire bed, also securely 
fastened at the corners and edges by safety-pins, to 
prevent creasing. A draw-sheet (a sheet folded in 
its length until it is about a yard and a-half in 
width), is fastened across the middle of the bed, 
the closed fold of the sheet is directed upward 
toward the head of the bed to prevent the ridges, 
which more readily occur when the open end of 
the sheet is directed upward. The cover-sheet, 
blanket and spread are then adjusted. Some 
prefer the patient's lying between blankets for a 
time ; the cover-sheet in such case may be dispensed 
with. 

As the patient may vomit when coming out of 
anaesthesia it is well to protect the pillow by plac- 
ing a piece of oil-cloth or rubber around it before 
drawing on the pillow-slip. A towel should be 
spread over the pillow before the patient is placed 
in bed, to protect the slip in like manner. If the 
pillow is not used, as it is often desirable to keep 
the head low, the towel may be spread over the 
upper end of the bed where the head will rest. 

The stands should have clean cover slips upon Muffling c 

1 x furniture. 

them. The feet of chairs, stands, or any movable 
furniture in the room should be muffled by twisting 
with a piece of roller-bandage or soft-muslin, so 
that they may be moved noiselessly; or rubber 



60 NURSING IN ABDOMINAL SURGERY. 

mufflers maybe obtained at large rubber stores for 
the same purpose. Care should have been exer- 
cised beforehand to see that door hinges, latches, 
and window frames, etc., are in proper order, so that 
there may be no unnecessary rattling or creaking 
produced by them. It is so essential to keep the 
patient free from irritation that all these little points 
should be carefully considered. 
neededfor ^ ^ s * °^ ^e principal articles needed in prepa- 
operation. ra tion for the operation will be as follows : — 

I strong kitchen table for the patient's body, 
i small table for patient's head. 

1 quiet-ticking clock. 

Rubber bags for hot water, metal foot-warmers, 
or soap-stone slabs or bricks for the application of 
dry heat. 

2 basins for catching fluid. 

2 large basins or new foot-tubs for sponges. 

2 flat trays, metal or hard rubber, for instruments ; 
basins may be used, though not as convenient. 

2 basins for the doctor's hands, to be used inter- 
changeably during operation. 

2 waste buckets, large size. 

2 buckets cold water. 
I bucket hot water. 

i full wash-stand set. 

I tea cup, graduated if possible. 

3 dozen old soft towels. 



THE PREPARATION OF THE ROOM. 6l 

I irrigator, either a Davidson hand-syringe, a 
fountain syringe, or a special contrivance consisting 
of a funnel, rubber tube, and long hard-rubber 
nozzle. 

1 thermometer for testing heat of water. 

i piece floor oil-cloth for protection of floor. 

4 pieces of rubber gum-cloth, I y 2 yards square, 
one for the bed, three for the protection of patient 
during operation. 

i piece rubber cloth for protection of pillow. 

2 pieces of new flannel, ^ yard wide, I y yards 
long, for abdominal bandage. 

2 pairs woolen hose. 

3 sets merino flannels for patient's under-wear. 

3 night-dresses. 

4 small horse-hair pillow T s, 8 x-io in., to use 
around patient for relief of pressure. 

3 new blankets. 
y 2 dozen sheets. 
I spread. 

1 or 2 mattresses. 

2 pads. 

2 large pillows, preferably of hair. 

i pin-cushion with shield and common pins. 

I set of antiseptic dressings. 

I lap absorbent cotton. 

I tray, with tumbler, feeder, teaspoon. 

l medicine glass. 



62 



NURSING IN ABDOMINAL SURGERY. 



I clinical thermometer. 

i piece Castile soap. 

i new nail brush. 

i vial bichloride tablets for cleansing the hands, 



etc. 



i pound Calvert's No. 4 carbolic acid. 
1 box of matches. 



Stand for 
cleansing 
sponges 

Stand with 
Sponges 



o 
o 



Fig. 5. 
r j Nurse 



■a 

'SO 



o 




Table for patient's body 



Q 



Operating 
Pad 



Window 



Receptacle for fluid 
under table extend- 
ing Slightly beyond 
edge . flap of opera- 
ting pad rests over it . 







Travis for 
Instruments 



o 



Stand with basin 
for operators hands 



Diagram showing Position, Operator, Assistant, etc. 
Assistant. 



when but one 



2 or 3 ruled reports. 

Pencil and paper for taking directions for after- 
management. 

Arrangement of operating table : — 

A table should be placed opposite a window, and. 



THE PREPARATION OF THE ROOM. 



63 



but a few feet from it, unless in a special operating 
room where the lighting of the apartment by 



Fig. 6. 



Receptacle. 
^or -fluid,, -under 
table 




Wijictozv 
Ward 



Tra$s-£Z3i L 

KJ(OperaioA T f 07 ~i s r 
Chief T f • V 1 SvBtrmn^\ 

-»r J JZl7llOl\ 

Nurse Assist t 



Spray 



Rents 

for 

Sponges 



Diagram showing Position, Operator, Assistants, etc., when two 

Assistants.* 

means of a sky-light may enable the table to 
occupy the centre of the space. 



* The Trendelenburg position employed by many surgeons in 
this day, when performing abdominal operations for pelvic disease, 
requires that the head of the patient should be lowered and the 
pelvis elevated. Special tables are devised for this purpose, although 
in their absence the ordinary operating table may be used by raising 
it at one end and placing boxes under the feet thus raised. The 
head of the patient in this case will have to be directed toward the 
window supplying the light, and the feet away from it, reversing 
the position as described in the diagrams. 



64 NURSING IN ABDOMINAL SURGERY. 

Various special forms of operating tables have 
been devised and are in use in different hospitals. 
Ordinarily, however, a plain, narrow, wooden table, 
such as is used in kitchens in this country, may be 
made to serve the purpose very well. A chair may 
be placed at the foot of the table unless the table is 
longer than the patient. This will support her feet. 
If it is not high enough, a stool or cushions may 
be so adjusted as to raise the feet and prevent 
tension of the abdominal walls. A better arrange- 
ment is the use of a small table, placed as in the cut, 
for the head. 

The table should be covered with a thick, folded 
blanket, or comfortable. A large piece of rubber 
cloth or table oil-cloth may be fastened across the 
middle, or better still, over the entire table, being 
fastened to its edges by tacks, to prevent slipping. 
In the Woman's Hospital a rubber army blanket is 
employed. A sheet is similarly fastened over this. 
A pillow protected by rubber is placed at the head 
of the table, and a folded blanket and sheet for 
covering the patient should be placed at the foot. 

If the carpet has not been removed from the 
room some protection must be used under the 
table, as a piece of floor oil-cloth, large enough to 
extend some distance around the table, or a piece 
of drugget or old carpet may be used, provided 
they are clean. 



THE PREPARATION OF THE ROOM. 65 

In a case of ovariotomy, or any operation where 
great quantities of fluid will probably need to be 
drawn off, a large foot-tub should be placed be- 
neath the table for the reception of the fluid,. also ' 
two basins, to be used interchangeably in receiving 
the fluid as it flows from the canula, and emptying 
it into the tub. 

Since the operator stands on the right side of the 
patient, the stand for his instruments should be 
placed near the foot of the table on the right side. 
Just back of the operator and a little to the right 
should be another stand or chair, upon which a 
basin of water for his hands should be placed, to 
be used during the operation. The water in this 
basin should be frequently changed by the nurse ; 
a slop-jar for the soiled water, and a pitcher from 
which the basin may be replenished may stand 
beside this table. 

The assistant stands opposite the operator, on 
the left side of the patient ; therefore to his right 
and toward the head of the table should be placed 
a small stand for holding a basin for the sponges, 
which, after being cleansed by the nurse, should be 
thrown into it in warm sterilized water. The nurse's 
stand with two large basins or small tubs filled, the 
one with cold, and the other with warm sterilized 
solution, should be placed a short distance back of 
this, so that the assistant may readily throw a 
5 



66 NURSING IN ABDOMINAL SURGERY. 

soiled sponge into the basin containing cold water. 
The nurse then thoroughly washing out the blood, 
will rinse the sponge through the warm water, and 
' place it in the basin to the assistant's right. A 
slop-basin and a tin mug, a pitcher or bucket of 
warm and one of cold sterilized water should stand 
by the nurse's table, so that there may be no delay 
in changing the water. 

A basin of water for the cleansing of her own 
hands should stand conveniently near, either on the 
stand or chair, so that in attending to the empty- 
ing and re-filling of the basin, she may cleanse her 
own hands before again touching the sponges. 

A small, light basin should be placed under the 
pillow on the table, to be at hand should the 
patient vomit. Three or four soft towels to be used 
by the etherizer may also be placed under the 
pillow. The irrigator with a pitcher or two of 
sterilized water of required temperature should be 
placed to one side, in readiness for use at any 
time. 

The window may be screened by a thin curtain 
of white muslin or lace fastened across the lower 
panes, or if necessary to protect the entire window 
from the intrusive gaze of outsiders, whiting may 
be painted over the inside of the panes, which will 
exclude observation, but admit light. 

When the operator works with two assistants 



THE PREPARATION OF THE ROOM. 



67 



besides the anaesthetizer the arrangement as indi- 
cated in Fig. 6 may be followed. 

Immediately before the operation, heated foot- 
warmers — bricks wrapped with towels or jars filled 
with hot water — should be placed in the bed, over 
the site upon which the patient is to lie, and under 

Fig. 7. 




Glass Graduate with Thermometer. 



the covers, so that the bed may be warm for her 
reception. 

A basin containing a block of ice and one or two 

soft towels may stand near the etherizer, as the 

* application of cold to the head during etherization 



68 NURSING IN ABDOMINAL SURGERY. 

aids frequently in controlling nausea and diminish- 
ing the subsequent headache. 

The restoratives which may be needed should 
the patient sink into collapse should be near at 
hand — brandy, digitalis, aromatic spirit of ammonia, 
etc., as the surgeon may desire. A hypodermic 
syringe in good condition for immediate use should 
also be provided. 

The irrigator or syringe to be used in washing 
out the abdominal cavity, and sterilized water 
should be kept in readiness for use when called 
for. Special receptacles for hot and cold sterilized 
water may be provided, or a large pitcher full of 
each, covered with towels to prevent contamination 
with dust, may be set to one side for the purpose. 
Another pitcher with distilled water at the required 
temperature (from 105 °-i io° Fahr.) should be kept 
in constant readiness, so that no time may be lost 
in preparing it. 

A bath thermometer, kept in the pitcher, enables 
the nurse to watch the temperature of the water, 
and to make an addition to it from time to time 
from the pitcher of hot water, so as to have it just 
right when wanted. A large glass graduate with 
thermometer attachment is used for the purpose in 
some hospitals. 

The Davidson hand-ball syringe used as a siphon 
will serve as an irrigator where no especial apparatus 



THE PREPARATION OF THE ROOM. 



6 9 



has been provided. The long rubber vaginal nozzle 
will need to boused, rather than the shorter nozzles. 
This syringe and the nozzles should, of course, be 
perfectly new when used for the purpose. 



Fig. I 




Apparatus for Irrigation of Abdominal Cavity. 



A representation of a very simple yet efficient 
irrigator is shown in the cut. 

A good plan where considerable water is likely 



JO NURSING IN ABDOMINAL SURGERY. 

to be needed for irrigation, is to have three or four 
pitchers of water of the required temperature ready, 
so that they can be used in quick succession, or a 
large glass vessel placed on a shelf, or hung some 
distance above the patient, may have the rubber 
tubing and nozzle attached, and may be kept filled 
with water of the temperature required. 



CHAPTER VI. 

PREPARATION OF SPONGES. 

The nurse should know something of the nature Description 
of sponges, in order to appreciate the necessity for 
a thorough cleansing of them prior to their appli- 
cation to surgical uses. The sponge is an animal 
found in the various seas, the fresh water forms 
being found in rivers and lakes. What we call a 
sponge is the skeleton of the animal. There are 
various species of sponges, some being much finer 
and softer than others. The latter are especially 
well adapted for use in delicate surgical work. 
These come to us largely from Turkey and are whe 
called the Levant sponge. The Dalmatian sponge 
is also a fine sponge. A similar species, though 
not quite so fine, is obtained from the Mediterran- 
ean. Two other species, the horse sponge and 
Zimocca sponge, of coarser quality, are also ob- 
tained from the Mediterranean. Florida sponges 
have of late grown much in favor, and are of a 
variety of species, some of which are very fine. 
Sponges grow at varying depths beneath the water, 
fastening themselves to rocks, stones, and other 

71 



nee 
obtained. 



J2 NURSING IN ABDOMINAL SURGERY. 

Methods of objects. The methods for obtaining them are by 
andpre n - g harpooning, diving, and dredging. After they are 

paring for - r . . i i • 

the market, taken from the water they are exposed to the air 
for some hours until they show a tendency to de- 
composition. They are then beaten with a thick 
stick, or trodden by the feet in a stream of flowing 
water, until the skin and outer soft tissues are com- 
pletely removed. 

After this cleansing they are hung up in the air 
to dry and then pressed into bales. If the sponges 

s^onges d are P ac ked before they are thoroughly dry a dis- 
ease, shown by the presence of orange-yellow spots, 
breaks out among them. This is called the 
" sponge cholera," or " pest." Some sponges are 
naturally of a dark brownish red near the base. 
This must be distinguished from the disease spots. 
In wholesale houses for selling sponges they are 
cut in shape and further cleaned. The light- 
colored sponges seen in drug stores have been 
bleached by the use of chemicals. Sponges are 
sold by weight, hence sand is often used as an 
adulteration. 

The pre- For hospital use sponges may be bought in 

paration of x . 

sponges in 2 ^ lb. bales, bleached and purified. When thus 

quantity J 7 1 

for hospital obtained and prepared they probably cost about 
Y^ cent each when ready for use. For private 
operations the surgeon usually provides his own 
sponges and attends to their preparation. 



PREPARATION OF SPONGES. 73 

The methods for cleansing sponges, as obtained 
by the bale, is as follows : — 



FOR CLEANING NEW SPONGES. 

Method No. i. — They must first be pounded in Methods 

for cleaning 

an iron mortar, or upon a flat stone, to break upandrender- 

1 * ing aseptic 

any particles of sand they may hold. Should they new 

J r J J J sponges. 

be very sandy it is well to soak them in a solution 
of muriatic acid (2 drachms to the pint) for a few 
hours. Wring them out in several clean, filtered 
waters until the water remains perfectly clear. 
Then immerse in a saturated solution of perman- 
ganate of potassium for an hour. After bleaching 
them with a ten per cent, solution of sulphurous 
acid (which does its work in an instant), again 
wring them out in several clean, filtered, and steril- 
ized waters until the water remains perfectly clear 
and transparent. 

Method No. 2. — After ridding the sponges of 
their sand according to the method described, 
wring them out of several clean waters. Then im- 
merse in a saturated solution of permanganate of 
potassium for an hour. Next put them into a 
saturated solution of oxalic acid and let them 
remain in this until bleached. They must then be 
rinsed in several waters (the water being filtered 
and boiled) until the water is perfectly clear. 



74 



NURSING IN ABDOMINAL SURGERY. 



Method for 
cleansing 
old 
sponges. 



Discolora- 
tion of 
sponges. 

Storing 
sponges. 



Prepara- 
tion for 
operation. 



TO CLEANSE OLD SPONGES. 

After washing them in cold water to remove 
the blood, let them soak from 10 to 12 hours in a 
saturated solution of baking soda, to free them 
completely of animal matter. Rinse in several 
waters, and immerse for an hour in the saturated 
solution of permanganate of potassium. After 
bleaching them with a saturated solution of oxalic 
acid, rinse them in several clean waters (boiled 
and filtered) until the water is clear. 

Of the methods described the first produces the 
prettiest sponges, as the bleaching process is more 
complete with the sulphurous than with the oxalic 
acid. Should the sponges during an operation get 
into a bichloride of mercury solution, it will be 
found that in recleansing them the sulphurous 
acid cannot be used, a chemical reaction causing 
a darkening of the sponge, so that, although clean, 
it looks unfit for use. 

After cleansing, sponges may be stored until 
needed in tightly covered glass jars, being im- 
mersed either in alcohol or in a solution of 
carbolic acid 1-40. 

Before operation the sponges thus stored should 
be thoroughly rinsed out in sterilized water and 
placed in a basin containing warm sterilized water 
until wanted. 

The number of sponges to be used during oper- 



PREPARATION OF SPONGES. 75 

ation should be carefully counted and recorded on importance 

J of record- 

a piece of paper, placed in some conspicuous place j^™™^ 
for the operator to see. An addition should ope' r "f ion 
never be made to the number of sponges in use 
during an operation without a corresponding change 
in the number marked on the paper. A sponge 
should never be cut in two without a similar pre- 
caution, as this will change the count, and a sponge 
may thus be lost sight of and allowed to remain in 
the abdomen. 

When the operator is ready to close the abdomen Counting of 

L J sponges, 

all the sponges should be counted by the nurse in 
a clear, loud tone, so that he may be assured that 
all are accounted for. 

The assistant, as a rule, takes the sponges out of 
the warm water and squeezes them dry as he de- 
sires them. Should this office devolve upon the 
nurse, she should see that they are well freed from 
moisture, and that they are warm when handed to 
the surgeon. 

Sponges which are to be carried down into the Mounted 

x ° sponges. 

abdomen for cleansing it should be mounted on 
rods called sponge-holders. Three or four of these 
should be in readiness. They will be needed at the 
close of the operation and must be handed in rapid 
succession as wanted. When thus placed in hold- 
ers or forceps they are called " mounted sponges." 

Flat sponges are used for protecting the intes- fponges. 



j6 NURSING IN ABDOMINAL SURGERY. 

tines, or for application of heat to the abdominal 
wall. It is well to keep these flat sponges in a 
separate basin of hot water, handing them when 
needed. Large squares of flannel wrung out of hot 
water are sometimes used in place of sponges for 
application of heat to the abdomen, or for covering 
over coils of intestine or omentum that may be 
drawn out of the wound during the course of an 
operation. 
f oJf^ 1 Artificial sponges are made by enclosing balls of 

sterilized absorbent cotton in sterilized gauze, fasten- 
ing this firmly with a few stitches so as to perfectly 
enclose the cotton. These balls may be made of 
varying sizes. They are used but the once and are 
thrown away or burned after the operation. They 
are largely used in place of the natural sponge in 
many of the hospitals in this country, hence the 
nurse should learn how to prepare them. She may 
also thus learn how to improvise sponges for use 
in a private house, in case of any emergency which 
may require them. 



CHAPTER VII. 

STERILIZATION OF INSTRUMENTS, ETC. 

The nurse receives the instruments from the 
surgeon and subjects them to a process of steril- 
ization by wrapping them in a clean dry towel and 
laying them in a dry or a steam sterilizer, according 
to the operator's wish. 

If dry sterilization is used, the temperature will Di y sterili - 

J * zation. 

require to be at least as high as I io° C, or 230 Fahr. 
In the steam sterilizer a temperature of ioo°-S tea ™" 

± stenliza- 

105 ° C, corresponding to 2i2°-22i° Fahr., is suf- tion - 
ficient. The rule in most hospitals is to keep the 
instruments in the sterilizer for about one hour, 
immediately preceding operation. At the time of 
the operation the instruments may be lifted out, and 
the towel around them being loosened they may 
be allowed to slip into sterilized trays containing 
warm sterilized water. The nurse's or assistant's 
hands should be thoroughly disinfected before this 
is done.* 

* The later forms of steam sterilizers contain a zinc trough in 
which the instruments may lie immersed in a I per cent, solution of 
carbonate of soda, during the process of sterilization. This prevents 
the rusting and discolorization of the instruments so often observed 
after the ordinary process. 

77 



78 



NURSING IN ABDOMINAL SURGERY. 



steriiiza- The method of sterilizing the dishes or trays 

tion of . ... . 

instrument which are to contain the instruments, is as follows : 
They should first receive a thorough cleansing with 
soap and warm water, and then should be filled 
with some strong antiseptic solution, as 1-500 or 
1-1000 bichloride of mercury — if of rubber or 



Immersion 
of instru- 
ments in 
antiseptic 
solution. 



Fig. 9. 




Arnold Steam Sterilizer. 



porcelain; if metal, a solution of carbolic acid 
1-20, or of beta-naphthol 1-2500 should be used. 
This may stand in the trays until they are needed 
for the instrument, when the antiseptic solution 
being emptied out is replaced by boiled distilled, 



STERILIZATION OF INSTRUMENTS, ETC. 79 

or filtered water. The trays should be about half 
full, so that the instruments may be well covered. 

All the towels and sheets in use around the pa- Sfenii»- 

A tion ot 

tient should be sterilized. Having been carefully ^S'etc 
laundried, they should be placed in the steam 
sterilizer for an hour preceding the operation, from 
which they can be removed as required for the use 
of the surgeons. In some hospitals they are steril- 
ized in quantity and stored in glass jars containing 
3 per cent, carbolic solution. 

When steam sterilization or dry sterilization f t ™^f n ° f 
cannot be effected for want of means, the towels, aJtueptL. 
etc., after a thorough boiling may be soaked in a 
solution of bichloride of mercury I-IOOO, or 
carbolic acid 1-20, and carefully dried in an oven 
or clean drying-chamber. After this they should 
be kept free from dust in large glass receptacles or 
closed boxes, or they may be stored in a carbolic 
acid solution. 

The sterilization of cheese-cloth or gauze, and Prepara- 

' tion of 

the preparation of bichloride gauze has already ^Jp^ 
been given in detail in the chapter on Asepsis and 
Antisepsis. The same formula may be followed 
in the preparation of carbolized gauze, borated 
gauze, etc. The strength of the solution -of the 
special substance to be used in each case will be 
given the nurse by the surgeon, should he require 
her to prepare the dressings. As a rule the strength 



8o 



NURSING IN ABDOMINAL SURGERY. 



Iodoform 
gauze. 



Provision 
against 
contamina- 
tion of anti- 
septic 
dressings. 



of the solution used in the preparation of the gauze 
is the same as the strongest solution of the agent 
as employed in irrigation. 

The formula for iodoform gauze is somewhat 
different. Methods for preparing it vary somewhat, 
but the following has been found very satisfactory: 
Six ounces of a I per cent, solution of carbolic 
acid and sterilized water should be prepared, to 
which is added sufficient castile soap to make a sud. 
Twelve drachms of iodoform powder should be 
thoroughly mixed with this. Three yards of gauze 
previously sterilized by steaming, baking, or boil- 
ing, may be prepared by saturating with this mix- 
ture. A basin, graduate, and glass rod, which have 
been previously sterilized, should be used in the 
making of the mixture and the preparation of the 
gauze. The same rule should be observed in dry- 
ing this gauze in the oven as before stated, that is, 
that a little glycerine should be sprinkled over it 
to prevent its becoming non-absorbent. The gauze 
may be cut and preserved in glass jars while moist. 

In cutting gauze into strips of the desired length, 
care should be taken not to contaminate it. A 
sterilized towel may be spread over a piece of 
rubber cloth which has previously been cleaned 
with some antiseptic solution; the gauze maybe 
laid down upon it and cut into the desired strips 
with a pair of sterilized scissors. The hands of 



STERILIZATION OF INSTRUMENTS, ETC. 8 1 

the nurse should be thoroughly disinfected prior 
to the operation of cutting the gauze. Strips of sizes of 
gauze 6 to 8 inches long and 4 inches wide are of 
good size; also pieces of gauze 4 inches square, 
some of which are folded so as to make triangles. 
These are especially nice for tucking around a 
drainage tube or serre-noeud. A large pad of 
several folds of gauze, or a pad of sterilized absor- 
bent cotton enclosed in gauze, and large enough 
to cover the whole abdomen should be in readiness. 
To prevent handling the dressings, the strips of storing of 

« . . antiseptic 

antiseptic gauze may be preserved in glass oint- dressings. 
ment jars of large size with glass lids, such as 
are used in drug stores. The nurse can then 
simply remove the lid and hold the jar near the 
surgeon, enabling him to help himself to the pieces 
as he needs them. 

A many-tailed bandage of new flannel and a pin- M an y -taiied 
cushion with safety pins will be necessary. bandage. 

The bandage, with the pad and strips of gauze special 
and a piece of rubber darn about 16 inches square, ressings * 
(also sterilized by soaking in carbolic or bichloride 
solution), with a sponge or sterilized cotton to be 
placed over the drainage tube, should be wrapped 
in a sterilized towel and placed to one side until 
needed, when the nurse should bring them to the 
operator. If a drying powder, such as boric acid D JJ^ S 
or iodoform, or the two combined, is used it is best 
6 



82 



NURSING IN ABDOMINAL SURGERY. 



Method of 
making 
many- 
tailed ban- 
dage. 



kept in a pepper-box or a small box with a piece of 
gauze tied over the top, so that the powder may be 
dusted on to the wound. 

The bandage should consist of a piece of new 
opera flannel (canton flannel or even thick muslin 
can be used). This should be properly shrunken. 
A piece sufficient for one bandage should be 



about Y^ yard wide and 



ll A~ ll A 



yards 



long. 



The sides should be torn toward the centre into five 
strips of equal width. A square of unbleached or 
any firm muslin, large enough to extend well 
beyond each side of the patient's loins, as she lies 
upon the bed, may be used as the base on which 
the middle portion of each one of five separate 
strips of flannel may be sewed. The strips should 
be closely basted on, each overlapping the preced- 
ing strip about ^ of its width. The muslin may 
be turned over the edges of the highest and lowest 
strip. The square of muslin and the strips should 
be whipped with cotton at the edges and not 
hemmed, as this makes an uneven surface to lie on. 
The bandage should be made longer or shorter 
according to the size of the patient. The object 
of the muslin square is to prevent the disagreeable 
sensation of flannel next the skin, particularly as 
in lying upon it the back is apt to become much 
heated. 

In putting this bandage on, it should be so 



STERILIZATION OF INSTRUMENTS, ETC. 83 

arranged that each succeeding strip overlaps the one A PP iica- 
already adjusted, starting from the upper part of bandage. 
the abdomen. Some surgeons use a perineal padTheperi- 

b r r nealpad. 

. in addition to the abdominal dressing. In that case 
a pad of sterilized gauze or cotton may be applied 
over the vulva and held in place by means of a 
napkin or towel fastened to the lower border of 
the abdominal bandage, both anteriorly and pos- 
teriorly. 

A word or two further may be said in this con- Rubber- 
dressing. 

nection concerning the india-rubber cloth used for 
protection of the drainage tube. A piece about 
one foot and a half square is necessary. A very 
small hole is cut in the centre of the cloth. The 
edge of the hole in the cloth is slipped over the rim 
of the tube and grips the neck of the tube. If 
properly put on this rubber cloth will catch any 
fluid which may escape in such quantity as to soak 
through the sponge or dressing placed over the 
mouth of the tube. At each dressing the nurse 
has simply to turn down the covers of this cloth, 
which had been folded over the tube and pinned. 
The tube is thus made accessible. The sponge, Protective 

1 & » sponge. 

when used to cover the orifice of the tube, should 
be a small conical sponge. During the drainage 
of the tube this sponge should be kept in an anti- 
septic solution until it is again needed. 

In hospital practice particularly it frequently de- 



/' 



84 NURSING IN ABDOMINAL SURGERY. 

Ligatures volves upon the nurse to prepare, or assist in pre- 

and sutures. . " 

paring, the ligatures and sutures. 

Ligatures are strands of silk or cat-gut, etc., used 
in tying bleeding vessels, or separating tumors, 
diseased organs, etc., from the tissues to which they 
are adherent. 

Sutures are strands of various materials, silver 
wire, iron wire, silk, silk-worm gut, cat-gut, etc., used 
in approximating the edges of wounds. 

Quality of T^he gjjj^. usec [ j n abdominal surgery is generally 
the best quality of " Surgeon's Cable Twist." Three 
sizes are usually required : fine for the superficial 
sutures ; medium or intermediate, for the deep 
sutures; and heavy for pedicles. This is the best 
silk for minor operations as well. 

Cat-gut. Cat-gut comes in similar sizes, and is required in 

the three kinds for the same purpose, if the surgeon 
prefers its use to silk. 

These should be wound on separate glass reels 
for sterilization before use. 

steriiiza- The reels containing silk should be put into glass 

tion of silk. ** r & 

tubes, like test-tubes, containing a wad of cotton in 
the bottom. The mouth of the tube should be 
plugged with cotton. The tubes may then be 
placed in a steam sterilizer or sterilizing oven for 
a time on three successive days — for one hour the 
first day ; ]/ 2 hour on the second and third days. 
It is said that thus sterilized it will keep indefinitely. 



STERILIZATION OF INSTRUMENTS, ETC. 85 

This method, as well as the following for the 
preparation of cat-gut, is employed by the surgeons 
in Johns Hopkins Hospital. 

Soak the cat-gut in bichloride of mercury solu- Prepara- ■ 

23 J tion of cat- 

tion 1-1000 for one hour, then in absolute alcohol s ut - 
one hour. Following this, soak for 48 hours in oil 
of juniper and wind on glass reels.* For y 2 hour 
before use the reels of "cat-gut may be placed in a 
jar containing alcohol and boiled in a water-bath. 

Ligatures should be cut both of silk and cat-gut, 
bunched and wound together, and placed in tubes 
for sterilization. Care must be taken to observe 
the different methods in sterilization of silk and cat- 
gut. 

Tubes should be prepared containing only one Y . xt v™*' 

r r o y tion of liga- 

size of ligatures. When sutures or ligatures are tures - 
wanted from a tube, the quantity needed may be 
removed and the tube replugged. The length of 
ligatures will vary with the requirements. Short 
ligatures of fine silk or cat-gut, 6-8 inches in length, 
are used for tying superficial vessels. A medium 
thickness will be needed for deeper and larger ves- 
sels, and the thickest strands for ligating the pedi- 
cles of tumors, etc. The latter ligatures will need 
to be from 40 to 50 inches long, as the pedicle must 
frequently be divided and the ligatures used to en- 
close considerable tissue. 

* Many surgeons omit the use of oil of juniper in this process. 



86 



NURSING IN ABDOMINAL SURGERY. 



Steriliza- 
tion of silk- 
worm gut 
and silver 



" Ignition 
tubes." 



Silk-worm gut and silver wire may be cut in 
proper lengths, 8-IO inches, and bunched together 
and doubled into test-tubes for sterilization, accord- 
ing to the same process as silk. 

The glass-tubes used for this purpose, which 
have recently been devised, have been called 



Fig. io. 




Ignition Tube containing Glass Reels wound with Silk, etc. 



Gauze for 
capillary 
drainage. 



" ignition tubes," and have the advantage over 
ordinary test-tubes in their greater durability. 

Should capillary drainage be employed the nurse 
will need to prepare pieces of gauze cut into nar- 



FlG. II. 




Ignition Tubes for Sterilizing Ligatures, etc., containing Glass Reels. 

row strips in suitable lengths for drainage tubes. 
These should be sterilized in ignition tubes, simi- 
larly plugged and used as required in the changing 
of the dressing. 



STERILIZATION OF INSTRUMENTS, ETC. 87 

A sufficient supply of sterilized dressings, gauze, 
cotton, etc., and another bandage should be kept 
in readiness for changes subsequent to the opera- 
tion. These should be carefully guarded from all 
contamination, hence should be wrapped in a steril- 
ized towel and kept in a closed box or drawer, or, 
if possible, in closed glass jars. 

The threading of needles for the operation some- Threading 

of needles. 

times devolves upon the nurse. In that case a 
tray with the needles already threaded and the 
ligatures and reels of sutures properly arranged 
should be in readiness for the surgeon. Long 
straight glovers' needles are those ordinarily used 
in abdominal section for the deep stitches. If the 
surgeon desires, these should be threaded at both 
ends. Four or five sets of these sutures at least 
should be prepared, as there is often considerable 
delay in rethreading. For the superficial stitches 
a smaller glover's needle with fine suture will be 
required. Curved needles may be preferred by 
some operators. The large needles are frequently 
used without being placed in a needle-holder. The 
smaller ones the nurse should place in the holder 
before she hands them to the physician. In seizing Method of 
the needle in the holder care should be taken not ^edifin 
to grasp it directly over the eye, but just beyond holder " 
it, as the eye is apt to split from the pressure. 
The silk and cat-gut may be carried through the 



NURSING IN ABDOxMINAL SURGERY. 



Carriers. 



eye, and occasionally silk-worm gut and wire are 
also thus threaded. In the latter case the strand 
should be carried but a short distance through and 
bent into a sharp angle at the point where it passes 
through, so that it may not catch on the tissues in 
passing through them. Silk-worm gut and wire 
are usually drawn through the tissues by the aid 
of strands or loops of fine silk, called " carriers/' 
into which the angle, made in the bent silk-worm 
gut or wire, may be hooked. The loop is made 



Fig. 12. 




Needle-holder. 



Pedicle 
ligatures. 



by passing the ends of the silk through the eye on 
the same side of the needle, crossing them and 
tying around the needle in a small knot. 

Ligatures for the pedicle are threaded into an 
instrument with an eye at the point, called " a 
pedicle needle." The operator usually has two or 
three of these. The long ends of the silk should 
be twisted around the instrument to prevent tang- 
ling, until the ligature is needed. 



STERILIZATION OF INSTRUMENTS, ETC. 



8 9 



A list of the instruments most commonly em- 
ployed for abdominal operations is as follows : — 
Scalpel. 



Fig. 13. 




Scalpels. 

Knife. 

Haemostatic, or pressure-forceps. 



Fig. 14. 




Pressure-forceps. 



Grooved director. 



Fig. 15. 




Grooved Director. 



90 NURSING IN ABDOMINAL SURGERY. 

Scissors (curved, straight, or angular). 

Fig. 16. 




Trocar. 



Volsella. 



Curved and Bent Scissors. 



Fig. 17. 




Trocar and Canula. 



Fig. 18 




Volsella. 



STERILIZATION OF INSTRUMENTS, ETC. 9 1 

Cyst forceps, or large pressure forceps, straight. 

Fig. 19. 




Cyst Forceps. 



Bent pressure forceps. 
T 



a « 



Fig. 20. 




T- Forceps. 



92 NURSING IN ABDOMINAL SURGERY. 

Retractors. 



Fig. 21. 




Retractor. 



Pedicle needle. 
Needle-holder (see Fig. 12). 



Fig. 22. 




Serre-nceud. 



Pedicle Needle. 
Fig. 23. 




Serre-nceud. 



STERILIZATION OF INSTRUMENTS, ETC. 93 

Pedicle pins. 



Fig. 24. 



B 
Pedicle Pins. 



Drainage tube. 

Syringe for draining tube. 

Needles. 



CHAPTER VIII. 



PREPARATION OF THE PATIENT. 



Necessity 
for previous 
prepara- 
tion. 



Daily bath. 



Daily vagi- 
nal injec- 
tion. 

Daily 

evacuation 
of bowels. 



Character 
of food. 



It is well, if possible, to have the patient under 
observation some days before operation, in order 
that she may have a thorough physical examina- 
tion, and also that the functions of skin, kidneys 
and bowels may be stimulated to their proper 
activity, if they have, as is so often the case, been 
sluggish from improper habits of living. 

If the patient is in fair condition a daily warm 
bath, with a thorough cleansing of the skin with 
soap and water, will be of advantage. On the day 
of the operation particular care will have to be 
taken in the cleansing of the site of the operation. 
This process will be described later. 

A daily vaginal injection of some antiseptic solu- 
tion is desirable. 

A daily evacuation of the bowels should be 
obtained by careful regulation of the diet, or, if 
necessary, by the use of laxatives and enemata as 
prescribed by the surgeon. 

The meals should be of such character as to leave 
as little residual matter in the bowels as possible. 

94 



PREPARATION OF THE PATIENT. 95 

Hence broths, milk, eggs, etc., should constitute a 
large proportion of the dietary. The patient should 
be well fed, but a careful selection of the articles 
for her meals should be made. 

The day before the operation it is well to employ t ^ p * f ra ~ 
a purge — one of the salines is usually employed ^5?^™" 
for the purpose, as a tablespoonful of Rochelle or^° r r a e tion 
Epsom salts by mouth : or the surgeon may prefer 
the use of a saline by enema. 

A combination frequently used by us is the fol- 
lowing : — 

2 tablespoonfuls of Rochelle or Epsom salts. 

2 " " Castor Oil. 

I " " Turpentine. 

I " " Glycerine. 

I quart of water (105 F.). 

These should be thoroughly mixed and carefully 
injected into the bowel. As a rule the bowels act 
freely within a short time after this injection has 
been received. To prevent any possible irritation 
of the bowel a small quantity, as 1 gill of saline 
solution [}/ 2 teaspoonful of salt to I gill water), may 
be injected into the bowel and retained after a free 
evacuation has been obtained. Should the salts be 
given by mouth the evening before an operation, a 
simple enema of soapsuds on the following morn- 
ing will be sufficient to produce a satisfactory 
evacuation. 



9 6 



NURSING IN ABDOMINAL SURGERY. 



vEStST 0n the mornin g of the operation a full bath 
TjlLt should be g' v en— a plunge bath of soap and warm 
water, if the patient is strong enough. If not, a 
sponge-bath may be given as the patient lies in bed. 
The abdomen should be shaved of all hair, par- 
ticularly the pubes. It is well to ask the surgeon 
whether he desires this done or not, as some sur- 



Fig. 25. 



Cleansing 
of site of 
operation. 




Aseptic Razor with Metal Handle. 

geons prefer doing it after etherization, if done at 
all. 

Cleanse the abdomen of all grease by rubbing 
over it a little turpentine, alcohol, or ether. This 
should be followed by again washing with warm 
water and subsequently with the antiseptic solu- 
tion 1-1000 bichloride of mercury. After this a 



PREPARATION OF THE PATIENT. 97 

dressing, wet or dry, of some antiseptic gauze 
should be bandaged over the part and kept in 
place until it is time for the operation. In this 
cleansing the umbilicus and pubes should be espe- 
cially well scrubbed with a nail brush ; all particles 
of dust and dirt should be gotten rid of. 

The patient's hair should be arranged in two Arrange- 

1 ° > ment of 

braids, one immediately behind each ear, the hair hair - 
being parted all the way down the back. This 
gives the patient a smooth surface to lie on, and 
prevents the matting of the hair, which is so apt to 
occur with any long-continued illness. 

Earring's should be removed, as they may catch Removal of 

. . . . earrings, 

in the clothing, and, if the patient struggles while fc^e teeth, 



etc. 



taking ether, the ear may be torn. False teeth 
should be removed, whether whole sets or single 
teeth, as they may be swallowed during etheriza- 
tion. They should be put away in a safe place. It 
is best to keep them immersed in a little fresh 
water. 

The patient should have on an entirely fresh suit clothing of 

J patient. 

of clothing, a merino undervest opened all the way 
down the front and brought together by tapes fast- 
ened two or three inches back from the edges, so 
that no gap may be left between when the- tapes 
are tied. Merino drawers and woolen stockings 
should be worn and a night-gown of especial pat- 
tern, having a short back-piece which reaches just 
7 



9 8 



NURSING IN ABDOMINAL SURGERY. 



Evacuation 
of bladder. 



Antiseptic 

vaginal 

injection. 



below the shoulders,. the front of the gown being 
long enough to reach to the knees. This avoids 
the thick folds and creases under the patient's back 
which the ordinary long night gown is so apt to 
produce. 

At least three suits of clothing should be pre- 
pared to have sufficient for the changes that may 
be necessary. The clothing should be of a size 
larger or two sizes larger than that ordinarily worn 
by the patient, as loose clothing is much more 
comfortable to lie in. 

The patient should pass water before operation, 
so that the full bladder shall not be in the way of 
the operator. If there is some abnormal condition 
which prevents her passing water, the catheter may 
have to be passed. But this is best done after 
etherization, both because it gives the patient less 
annoyance and because it is desirable to accurately 
locate the bladder at the time of operation. 

A vaginal injection of bichloride of mercury I— 
4000, should be given just before the operation. 
Occasionally the operator prefers to have it given 
after the patient is placed upon the operating table. 

These preparations should be made in some 
other than the operating room, and the patient, 
after she is ready, may lie down on a bed between 
sterilized sheets until she is etherized. 

The patient should take no food on the morning 



PREPARATION OF THE PATIENT. 99 

» 

of the operation. If the operation is not to take Abstinence 

from food, 

place until noon or later, a cup of hot coffee or tea, 
according to her choice, may be given her. Milk 
should be avoided because of its tendency to form 
curds (especially under the effect of strong nervous 
excitement), which may remain in the stomach, and 
being vomited during etherization tend to choke 
the patient. The patient should remain in bed on 
the morning of the operation, to avoid feeling faint 
for want of food. 

Coverings. — During the operation the patient 
should be so wrapped that as little as possible of 
the body heat shall be lost. 

A warm blanket may be folded over the lower Arrange- 

' ment of 

limbs, or wrapped around them and fastened with clothin s 

rr prepara- 

safety pins, if it is desired thus to keep the limbs ^^Son 
immovable. If the surgeon desires to be able to 
separate them or bend them from time to time, they 
may be separately wrapped and pinned in blankets. 
The clothing of the chest should be folded back, 
being drawn above the shoulder-blades and on a 
level with the breasts, and thus fastened with safety 
pins. The sleeves may similarly be rolled up above 
the elbows, sterilized towels being twisted around 
the uncovered portion of the arm, the end of the 
twist at the wrist being tucked under the patient's 
body as the arms are stretched out at her sides. A 



IOO NURSING IN ABDOMINAL SURGERY. 

different disposition of the arms will be required if 
the operating pad is used. They may in the latter 
case be bent at the elbow, the fore-arms resting 
upon the pillow and covered by the clothing of 
the chest. A blanket or a piece of flannel may be 
placed over the patient's chest, or a layer of cotton 
wool may be put under the merino vest. If it is 
necessary to take extra care about keeping the 
patient warm, a rubber bag filled with hot water 
may be placed at her feet, or rolls of wool wrapped 
around the limbs under the blankets. 
Protectives. Different surgeons have various devices for pro- 
tecting the patient's clothing during operation. 
Special pads of rubber may be adjusted under the 
patient's back and thighs, which will serve to carry 
off the water used in irrigation or any liquid 
spilled. A very simple and effective arrangement 
is that afforded by three sheets of rubber protec- 
tive, each \y 2 yards wide and 2 yards long. One 
of these may be slipped under the patient's back, 
covering the arms at the side, the ends hanging 
down over the sides of the table. Another is so 
adjusted as to cover the chest, being folded under 
the clothing front and back. 

Towels may be so arranged in covering the rub- 
ber that it does not come in direct contact with the 
skin. The third piece of rubber sheeting covers 



PREPARATION OF THE PATIENT. 



IOI 



the blanket over the lower limbs, being turned 
down over the edge of the blanket on a line with 
the pubes. A sterilized sheet may be spread over 
this rubber sheet and similarly turned down. 
Sterilized towels may then be placed on the chest, 
over the sheet covering the lower limbs ; also, 

Fig. 26. 



\_*i.<VL%i.*=S»Vb 




Arrangement of Operating Pad in Abdominal Section. 



covering the rubber cloth at the sides of the patient. 
The dressings applied over the abdomen should 
not be removed until the operator is ready to pro- 
ceed to his work. 

Some operators prefer retaining a catheter in 



102 NURSING IN ABDOMINAL SURGERY. 

Retention the bladder as a guide during the operation. In this 
in bladder, case a shallow urinal or ordinary soap-dish may be 
slipped between the limbs to catch the urine as it 
flows out. 

All this adjustment of clothing, protectives, etc., 
can be made in a very few minutes after etheriza- 
tion is complete. 



CHAPTER IX. 

PREPARATION OF OPERATOR AND ASSISTANTS. 

The operator, his assistants, and nurses should be 
thoroughly prepared for the grave work they are 
to undertake by especial attention to personal personal 
cleanliness. A full bath with an entirely fresh suit of c * 
clothing, as described in the chapter on the Surgical 
Nurse, will be sufficient so far as concerns the 
general preparation of the person. The hands and 
arms will need further attention for their especial 
sterilization. The method which originated, I Ar , , . 

*3 ' Methods of 

believe, in the Johns Hopkins Hospital and has ^andsand 
since been employed in other institutions, has ' 
been found very satisfactory. The hands and 
fore-arms being thoroughly scrubbed with soap 
and warm water for several minutes, the finger- 
nails having previously been carefully cleaned 
and cut, the hands are immersed for about one 
minute in a saturated solution of permanganate of 
potassium, which is well rubbed into the skin. 
The hands are then bleached in a saturated solution 
of oxalic acid. The oxalic acid solution is then 
washed off with distilled boiled water and the 

103 



, arms, 



104 



NURSING IN ABDOMINAL SURGERY. 



Surgical 
aprons. 



Avoidance 
of contami- 



hands finally immersed in a solution of bichloride 
of mercury from i-iooo to 1-5000 for about one 
minute. It is claimed by the originators of this 
method that cultures taken from beneath the finger- 
nails of hands thus cleaned have been found to be 
absolutely sterile.* 

The staining effect of permanganate of potas- 
sium, which remains to some extent even after the 
use of oxalic acid, if the hands be thus frequently 
cleansed, is the chief objection to this method. It 
is well probably to employ it, should one be 
obliged to operate shortly after the handling of 
discharges of a foul nature. The immersion of the 
hands in alcohol, after a thorough cleansing with 
soap and water, and their subsequent immersion in 
a strong bichloride solution, is probably sufficient 
for producing an antiseptic condition in ordinary 
cases. 

Before beginning the operation, the operator and 
his assistants should put on long white linen 
aprons, enveloping the whole person, which should 
previously have been sterilized by steaming in the 
Arnold apparatus for one hour before operation, or 
by superheating in the sterilizing oven for a similar 
length of time. 
' During the operation the surgeon and his assist- 

* The efficacy of the bichloride of mercury solution is said to be 
increased by a previous immersion of the hands in alcohol. 



PREPARATION OF OPERATOR. IO5 

ants should carefully avoid touching anything that 
may contaminate their hands. Should they have 
to do so, the process of recleansing the hands 
should again be gone through with. A frequent 
dipping of the hands into the warm sterilized water 
provided will keep them free of blood and also con- 
duce to greater safety in the performance of the 
operation. 

A summary of directions to be observed in the 
preparation for all operations performed in his clinic 
in general surgery is given as follows, by Dr. J. B. 
Roberts, comprising in concise form the principles 
to be observed in all such work. 

RULES TO BE OBSERVED IN OPERATIONS. 

High temperature and suppuration after wounds 
or operations are usually due to blood poisoning, 
which is caused by infection with vegetable para- 
sites called bacteria. These parasites ordinarily 
gain access to the wound from the skin of the 
patient, the finger-nails or hands of the operator or 
his assistants, the ligatures, sutures or dressings. 
Suppuration and high temperature, therefore, should 
not occur after operation wounds, if suppuration 
has not existed previously. 

Bacteria exist almost everywhere as invisible 
particles in the dust ; hence, everything that touches 
or comes into even momentary contact with the 



I06 NURSING IN ABDOMINAL SURGERY. 

wound must be germ free ; technically called 
" sterile." A sterilized condition of the operator, 
the assistant, the wound, instruments, etc., is ob- 
tained by removing all bacteria by means of ab- 
solute surgical cleanliness (asepsis,) and by the use 
of those chemical agents which destroy the bacteria 
not removed by cleanliness itself (antisepsis.) Sur- 
gical cleanliness differs from the housewife's idea 
of cleanliness, in that its details seem frivolous, 
because it aims at the removal of microscopic 
particles. Stains such as housewives abhor, if 
germ free, are not objected to in surgery. The 
hands, arms, which should be bare to the elbow, 
and especially the finger-nails of the surgeon, assist- 
ants and nurses should be well scrubbed imme- 
diately before the operation, with hot water and 
soap, by means of a nail-brush. The patient's body 
about the site of operation should be similarly 
scrubbed with a brush and cleanly shaven. Sub- 
sequently the hands of the operator, assistants and 
nurses, and the field of operation should be im- 
mersed in, or thoroughly washed with, corrosive 
sublimate solution (i-iooo or 1-2000.) 

Sometimes the surgeon prefers to use for his 
hands and arms, and to have the assistants and 
nurses use for their hands and arms, a saturated 
solution of potassium permanganate. This is em- 
ployed, after hot water and soap have been used as 



PREPARATION OF OPERATOR. \OJ 

detailed above, and should be thoroughly rubbed 
into the crevices around and under the finger-nails. 
The brown stain which it gives the skin is then 
removed by thorough washing in a saturated solu- 
tion of oxalic acid. The oxalic acid solution is 
next rinsed off by water which has been made sterile 
by boiling, and the hands and arms finally w T ashed 
in a solution of corrosive sublimate (i-iooo or i- 
2000). 

Finger rings, bracelets, bangles, and cuffs worn 
by the operator, assistants or nurses must be re- 
moved before the cleansing is begun, and the cloth- 
ing covered with a clean white apron large enough 
to extend from neck to ankles and provided with 
short sleeves tied around the arm above the 
elbow. 

The instruments should be similarly scrubbed 
with hot water and soap, and all particles of pus 
and blood from any previous operation removed 
from the joints. After this they should be boiled 
for at least fifteen minutes in a one per cent, solution 
of sodium carbonate, which must be sufficiently 
deep to cover every portion of the instruments. 
After cleansing the instruments with soap and 
water, baking in a temperature a little above the 
boiling point may be used as a method of steriliz- 
ing. During the operation the sterilized instru- 
ments should be kept in a beta-naphthol solution 



108 NURSING IN ABDOMINAL SURGERY. 

(1-2500) or in sterilized water, and returned to it 
when the operator is not using them. 

Sponges should be kept in a sterilized solution, 
or a corrosive sublimate solution, during the oper- 
ation. After the blood from the wound has been 
sponged away, they should be put in another basin 
containing antiseptic solution and cleansed anew 
before being used again. The antiseptic sutures 
and ligatures should be similarly soaked in a beta- 
naphthol solution, or a sublimate solution, during 
the process of the operation. 

No one should touch the wound but the operator 
and his first assistant. No one should touch the 
sponges but the operator, his first assistant and the 
nurse having charge of them. No one should 
touch the already prepared ligatures or instruments 
except the surgeon and his first and second assist- 
ants. None but those assigned to the work are 
expected to handle instruments, sponges, dressings, 
etc., during the operation. 

When any one taking part in an operation touches 
an object not sterilized, such as a table, a tray, or the 
ether towel, he should not be allowed to touch the 
instruments, the dressings or the ligatures until his 
hands have been again sterilized. It is important 
that the hands of the surgeon, his assistants and 
nurses should not touch any part of his own 
or of the patient's body, because infection may be 



PREPARATION OF OPERATOR. IO9 

carried to the wound. Rubbing the beard or head, 
or wiping the nose, requires immediate disinfection 
of the hands to be practiced. 

The trailing ends of ligatures and sutures should 
never be allowed to touch an assistant's or surgeon's 
dress, or to drag upon the operating table, because 
contact may occasionally, but not always, pick up 
bacteria, which may cause suppuration in the 
wound. 

Instruments which fall upon the floor should not 
be again used until thoroughly disinfected. The 
clothing of the patient in the vicinity of the part 
to be operated upon, and the blankets and sheets 
used to keep him warm, should be covered with dry 
sublimate towels, and all dressings should be kept 
safe from infection by being stored in glass jars or 
wrapped in dry sublimate towels. 



CHAPTER X. 



THE NURSE'S DUTIES DURING OPERATION. 



Personal 
cleanliness 
of nurse. 



After a careful preparation of the room and of 
the patient, according to the instructions laid down 
in the preceding chapters, the nurse will need to 
make the changes in her own toilet necessary to 
her attendance upon the operation. Her hands 
and fore-arms will need to be rendered thoroughly 
aseptic, and a clean apron with sleeves put on. 
The general bath and change of clothing should 
have been obtained before her preparation of the 
patient. 
Arrange- When ready herself the nurse should assist in 

ment of - . - ... . » 

patient for taking the patient into the operating room, placing 
her on the table and arranging the clothing and pro- 
tectives. After doing this, if she is not otherwise 
directed by the surgeon in attendance, she can see 
to arranging such details as have had to be left to 
the last ; as placing sterilized water of the proper 
temperature in the various vessels provided for the 
purposes of irrigation, cleansing of sponges and 
hands, etc. A good temperature to start with is 
no° or 1 1 5° Fahr. 

no 



NURSE S DUTIES DURING OPERATION. I I I 

She should see that hot bottles or foot-warmers Warming 
are placed in the bed which is to receive the 
patient after operation. She should take a careful 
survey of the room and see that everything is in 
its proper place, that is, where it may be most 
readily obtained when wanted. 

After assuring- herself that all is right, she should Manage- 

° ° merit of 

recleanse her hands and take up her station at the s P° n s es - 
stand where she is to manage the sponges. 

As rapidly as the soiled sponges are thrown into 
the cold-water basin, she should cleanse them of 
blood, rinse them out of the hot water, and place 
them in the basin on the stand to the assistant's 
right. 

She should keep her eyes open to the needs of special 

, , . , . duties. 

the operator and his assistants, supplying sponges, 
clean towels, etc., as needed ; keeping the water in 
the various basins changed as it becomes soiled, 
and finally assisting with the removal of the soiled 
clothing, the application of dressings, and the re- 
moval of the patient to the bed. While the surgeon 
is completing his application of the dressings the ^^ofted 
nurse should turn back the covers from the bed, [? r n r ^ ep " 
and remove the hot-water bottles, etc., temporarily, patlent ' 
placing them under the bed to be out of the way 
until the patient has been placed in bed, when they 
may be replaced around her. 

The nurse's hands should be frequently cleansed 



112 NURSING IN ABDOMINAL SURGERY. 

as she passes from one thing to another in her 
attention to the various details of service. 
Attention When the patient has been placed in bed and 

after patient A * 

^placed in wa rmly covered with blankets, the hot applications 
being placed around her, a towel should be placed 
under her chin, a light basin under the head of 
the bed to be on hand should she vomit, and a 
towel wrung out of cold water may be placed 
upon her forehead. The blinds or screens should 
be so arranged that the light in the room may be 
modified. A chair for the surgeon may be placed 
at the head of the bed, and, as he or his assistant 
takes his place there, the nurse may attend to 

fromroom speedily removing the things used during the oper- 

useTduring ation, as tables, protectives, etc., from the room. 

operation, ^hese may be placed temporarily in an adjoining 
room, until the nurse or some one who volunteers 
to assist her may see the different articles taken 
back to their respective places in the house. 

Care of Sheets, etc., soiled with blood, should be placed 

soiled _ m _ 

clothing. in a tub to soak. This will render the washing of 
them quite easy, as the blood being well-rinsed out 
of them, they may then be placed in the ordinary 
wash, unless it is preferred to do them separately. 

ventilation Screens being placed around the bed to prevent 

of room. - • » r i- 1 t 1 i • i 

the patient s feeling the draught, the windows 
should be raised and doors opened to thoroughly 
change the air in the apartment. This may more 



NURSES DUTIES DURING OPERATION. I 1 3 

effectually be done by "pumping the door," as it is 
called, that is rapidly opening and closing it, 
without latching, so as to use it as a fan as it 
swings upon its hinges. 

When the surgeon has to leave the patient, the The " urse ' s 

x watch over 

nurse must take up her station by the bed. LikeP ati ? n . t,s 

± J condition. 

a sentinel on duty, she should be vigilant in her 
watch, noting every symptom promptly and meet- 
ing its demands. Until the patient is well out of 
ether the nurse should not entrust her care, even 
for a moment, to any inexperienced person. 



CHAPTER XI. 

THE NURSE'S DUTIES AFTER OPERATION AND 
DURING CONVALESCENCE. 

The immediate duties of the nurse after opera- 
tion will depend much upon the condition in 
which the patient has been put to bed. 
Treatment If the condition of shock be profound, vigorous 

of shock. . . 

measures may be necessary to produce a reaction. 
The application of dry heat, by means of blankets 
heated in an oven and tucked closely around 
the patient, and of pieces of flannel heated and 
placed over the chest immediately next the skin, 
serves to stimulate the circulation. The extremi- 
ties may be rubbed with whisky or brandy, the 
nurse's hands being carried under the blankets to 
avoid exposure to air. The head should be kept 
low, even lower than the feet, in order to keep up 
the circulation of blood in the brain The foot of 
the bed may be elevated for this purpose, being 
raised by means of bricks or stools, or a high chair 
upon which a stool has been placed may be slipped 
under the foot-board. 

The patient may be fanned, and hartshorn 
sprinkled on a handkerchief or towel held near the 

114 



NURSES DUTIES AFTER OPERATION. I I 5 

nostrils. Should further measures be necessary 
the nurse may, with the sanction of the surgeon, 
give hypodermic injections of some stimulant. 
Brandy or whisky may be thus given, or solutions 
of caffeine, strychnia, or digitalis. These are in- 
tended to strengthen the heart's action, and, if 
doing their work properly, the effect should be soon 
noted in the pulse. It should grow stronger and 
slower. The frequency with which these injections H yP oder- 
should be given and the amount given at one time, sdmXnts 
will in every case need to be regulated by the sur- m 
geon. Careful instructions must be obtained from 
him. The full 30 minims of brandy or whisky 
may be given, filling the barrel of the syringe full. 
Ten to fifteen minims of tincture of digitalis gen- 
erally constitutes a dose. It may be diluted in 
sufficient water to fill the barrel of the syringe. One 
to two grains of caffeine in solution, or -^ gr. ot 
strychnia in solution, may be given by computing 
the dose according to the strength of the solution 
compounded. 

The hypodermic syringe is a delicate instrument Care 01 h y - 
and should be carefully managed and kept in good syringe, 
order, so that it may be ready for use at any time. 
The barrel may be of metal, glass, or rubber ; the 
nozzle or needle of gold, silver, or steel. The 
latter should be very sharp, hence the point should 
be kept well protected. If dulled its introduction 



n6 



NURSING IN ABDOMINAL SURGERY. 



will cause pain. After use, a fine gold wire should be 
run through it, from the point of the needle 
upward, to keep out dust, etc. The barrel should be 
kept filled % full of water to keep the packing of 
the piston soft* Should the packing become loose, 
draw out the piston and slip the finger-nail around 
the upper part of the packing, and spread it a little 
and soak in a little warm water for a time. A 
screw-piece attached to the piston enables a more 

Fig. 27. 




Hypodermic Needles and Syringe. 



Method ot 
hypoder- 
mic injec- 
tion 



accurate regulation of the dose, when it has to be 
estimated in minims. In administering the injec- 
tion take hold of a portion of the upper part of the 
arm or thigh and hold it firmly for a little time to 
benumb sensation ; then insert the needle quickly, 

* Some surgeons prefer anointing the packing with a little gray 
mercurial ointment to prevent its drying, and not using the water, 
which, unless it consists of some antiseptic solution, does not keep 
the syringe in an aseptic state. 



NURSES DUTIES AFTER OPERATION. II7 

but not too deeply, straight down into this mass and 
carefully inject the fluid. After withdrawing the 
needle put your finger over the point from which 
it was withdrawn, and rub over the place for a little 
time to prevent any of the fluid coming back. 

When the patient's strength is low, stimulating stimulating 

or nutrient 

or nutrient enemata are often given. For simple enemata. 
stimulation a gill of black coffee, strained and care- 
fully injected into the bowel, is excellent. Another 
stimulating injection is one consisting of I table- 
spoonful of whisky, and I of elixir of the valeri- 
anate of ammonia in about y 2 pint of starch or rice- 
water. This helps to quiet nervous excitement. 

As a feeding enema, milk, beef-tea, broth, etc., 
alone or combined with stimulants, mav be 
employed. All feeding enemata should be pep- 
tonized, to render their digestion and assimilation 
easier, for there is but little digestive power in the 
lower bowel. 

The amount given to an adult at one time should 
not exceed i gill, and should not be given oftener 
than once in 3 or 4 hours. It is better to give highly 
concentrated food, rather than to give these injec- 
tions too frequently, for the bowel is thus irritated 
and will not retain the food given. 

A tablespoonful of expressed beef-juice, which 
represents the nutriment from ^ pound of beef, 
may be combined with a gill of warm water, to 



u8 



NURSING IN ABDOMINAL SURGERY. 



which whisky or brandy may be added from I 
teaspoonful to I tablespoonful, according to the 
surgeon's desire. 

This given once in 3 hours will represent consid- 
erable nourishment. Medication may be combined 
with the food thus given, as 15-20 drops tincture 
of digitalis or aromatic spirits of ammonia. 



Fig. 28. 




DAVIDSON RUBBER CO. 

Davidson Syringe. 



Method of 
giving in- 
jections. 



The injection should be given at a temperature 
of 100 Fahr. If too warm or too cold, it will 
stimulate the action of the bowels. 

An ordinary Davidson hand-ball syringe may be 
used as a siphon for the introduction of this enema 
from the cup containing it. Care should be taken 
to inject no air into the bowel. It is well to intro- 
duce a vaginal nozzle into the bowel a few minutes 



nurse's duties after operation. 119 

before the time for giving the enema, to allow of the 
escape of any gas that may have collected, and 
thus better insure the retention of the food. A 
bowel used thus for purposes of nutrition should 

be washed out at least once daily, to remove any Washing 
11 1 11 out bowel - 

residue that may collect and prevent ready absorp- 
tion. This may be done by injecting a pint of warm 
water in which has been dissolved a teaspoonful of 
salt. If this is not voluntarily evacuated a nozzle 
may be inserted to draw it off. To administer 
the stimulating enema itself, all air is first expelled 
from the syringe by keeping the ends beneath the 
surface of the mixture and compressing the bulb 
until no bubbles are produced. A little vaseline 
may then be used to anoint the nozzle, which is 
then carefully insinuated into the bowel. If the 
direction of the lower bowel is remembered by the 
nurse as first extending for a short distance toward 
the vagina and then inclining backward, there will 
be no difficulty experienced in introducing the nozzle 
without causing any pain. The nozzle must then be 
held in place. The patient, if strong enough, can 
do this for herself, and the nurse will raise the vessel 
containing the mixture to be injected. As soon as 
the last of the liquid flows into the syringe, the 
tubing should be compressed while the nozzle is 
withdrawn. This is to prevent the introduction of 

11 1 a 1 • 1 1111 Method of 

air into the bowel. A napkin may then be held insuring re- 
tention. 



120 



NURSING IN ABDOMINAL SURGERY. 



Period in 
which 
danger 
from hem- 
orrhage ; 
from 

inflamma- 
tion ; from 
blood-poi- 
soning. 



Symptoms 
of internal 
hemor- 
rhage. 



Primary 
hemor- 



rhage. 



Secondary 
hemor- 
rhage. 



firmly applied for a time to the anus, until the 
irritability of the bowel ceases. 

The addition of white of egg beaten into the 
mixture, or a teaspoonful of starch or arrowroot, 
will serve to make the liquid injected less irritating 
to the bowel. When the bowel becomes non- 
retentive the addition of from 10 to 15 drops of 
laudanum to the enema may enable it to be re- 
tained. Opium in any form should not be used 
without the express direction of the surgeon. If 
preferred, a barrel and piston syringe may be used 
in giving these injections. 

The precaution should be taken to inject the fluid 
very slowly. 

The greatest danger in the first twenty-four 
hours after operation is from hemorrhage ; in the 
first three or four days from inflammation ; and the 
first ten days from blood-poisoning. The nurse 
should look frequently at the dressings and the 
clothing under the patient's back to see if there be 
any bleeding. 

If there is internal bleeding it will show itself by 
the patient being faint, white or blue around the 
lips, and the pulse becoming very faint and rapid, or 
else altogether lost. Hemorrhage occurring in the 
first twenty-four to forty-eight hours after operation 
is called primary hemorrhage. Secondary hemor- 
rhage comes on generally in the second week. 



NURSES DUTIES AFTER OPERATION. 121 

Reaction after operation is shown by the patient's Reaction 

1 J x alter opera- 

speaking, the pulse getting stronger and the skin tion - 
becoming moist and warm. When this occurs it 
is undesirable to keep up too much artificial heat 
about the patient. The heated bottles, etc., around 
her may therefore be removed. 

The temperature, pulse, and respiration of the Record of 

tempera- 
patient should be taken immediately after she is ture, etc. 

placed in bed, and after that every 3 hours for the 

first few days. The temperature is best taken in 

the armpit. 

For the sake of uniformity it is well to make the special 
record of temperature, pulse, etc., come at 12, 3, 6, to be noted. 
and 9 o'clock. 

The nurse should note all symptoms accurately 
and report them carefully. If the patient is uneasy 
or complains of pain, note this down in the record. 
If she is sick or vomits, report the time, quantity, 
and appearance of the matter vomited. 

During any retching or vomiting the nurse should 
place one hand over the site of the wound, to pre- 
vent undue strain upon the stitches or the forcing 
out of the drainage tube. 

The quieter the patient is kept the better, there- 
fore no conversation should go on in the room. 
Do not let the patient lift her head or move her 
limbs. Report chills or chilliness. Give just as 



122 NURSING IN ABDOMINAL SURGERY. 

little nourishment as possible for the first few days, 
unless directed otherwise by the surgeon. 

Manage- The ordinary rule for feeding after a laparotomy 

diet - is as follows : — 

For first 24 hours absolutely nothing, not even 
ice or water. If the lips and mouth are much 
parched with ether, a small soft piece of linen cloth 
may be dipped in cold water and used to moisten 
the mouth and tongue. 

If the stomach is settled the patient may on the 
second day take a teaspoonful of barley water every 
hour. If this is retained she may on the third day 
have a teaspoonful of milk combined with the 
barley water. When the bowels have been once 
thoroughly moved, as they should be by the third 
day, the dietary may be increased. The food at 
first should be concentrated rather than large in 
quantity. As the amount is increased the intervals 
should be lengthened, thus, a tablespoonful of 
expressed beef-juice may be given alternating with 
a tablespoonful of milk once in two hours. 

Should the liquid diet tend to produce flatulence, 
bread-crumbs may be used with the milk and beef- 
juice, or a partial semi-liquid diet may be substi- 
tuted ; thus, farina, junket, wheat-germ, thickened 
milk, koumiss, toast milk, w r ine whey, strained 
gruel, rice, milk-toast, broths containing rice or 



NURSES DUTIES AFTER OPERATION. 1 23 

barley may gradually be substituted. By the close 
of the second week the patient may gradually 
resume ordinary, plain, wholesome fare. The 
occasional use of a baked apple, or a dish of stewed 
apples, will aid in regulating the bowels. Should 
the patient's stomach be retentive and her general 
condition good, an occasional drink of very weak, 
hot tea, in place of the barley water, on the second 
and third days will be found, by relieving the feel- 
ing of exhaustion, to steady the nerves and add to 
the patient's comfort. For the control of vomiting Control of 

x ° vomiting. 

various devices have been recommended. 

As the vomiting after ether is largely the result 
of cerebral congestion, it is desirable to keep the 
head cool by the application of cloths rung out 
in ice-water or ice-bags. This relieves also the 
accompanying headache. 

A mustard-paste placed over the stomach will 
be sedative in its effect upon the vomiting. Should 
the tendency continue notwithstanding this treat- 
ment, a feeder full of very hot water containing a 
small pinch of salt may be sipped by the patient. 
This will probably come up, but will serve to quiet 
the tendency to retching. Another means which 
is often effectual is that of injecting about j4 pint 
of warm water (105 Fahr.) into the rectum and 
having it retained. 

Intestinal colic is frequently complained of, es-;^ tinal 



catheter 



124 NURSING IN ABDOMINAL SURGERY. 

pecially during the second and third day. It is 
caused by the accumulation of gas in the intestines. 
There is apt to be such an accumulation in the 
large bowel, just below the diaphragm, causing the 
patient often to cry out with pain. The use of a 
warm flaxseed poultice over this region will relieve 
the pain and enable the gas to work down into the 
lower bowel. The use of the vaginal nozzle in the 
rectum will enable it often to be expelled and thus 
relieve the pain. The drink of hot tea or very hot 
water will also aid in this result. 

Fig. 29. 




\_SLWVZ- ^sows 



Glass Catheter. 



Use of The nurse should learn .from the surgeon what 

his desire may be concerning the use of the catheter. 
Unless especial directions are given the catheter 
may be used once in six hours. 

After hysterectomy it may be necessary to empty 
the bladder once in every three or four hours, if 
the stump is so situated as to interfere with its 
proper distention. The silver or glass catheter 
should be used, or the soft rubber catheter. Great 
care should be exercised by thorough cleanliness 



nurse's duties after operation. 125 

to produce no irritation from its use. The instru- 
ments, if glass or silver, should be boiled after each 
use, and kept in the intervals in a weak solution, 
1-40, of carbolic acid. The part around the orifice 
of the urethra should be carefully cleansed before 
the insertion of the catheter. The catheter itself 
should be well lubricated with a little carbolized 
vaseline. 

It is probably best to insert the catheter by sight, Methods of 
the efforts to do it by touch, unless one is especially catheter, 
skilled, often inducing irritation. The patient may 

Fig. 30. 




Coach Urinal. 

be so protected by the covers that but little ex- 
posure is necessary in its use, a blanket or sheet 
being thrown over each limb, the urinal being 
placed between them. Should the nurse be able to 
use the catheter by touch, the operation can be per- 
formed without any exposure beneath the covers. 
The index finger of the nurse's right hand should 
be slipped into the vagina as far as the second joint, 
and made to follow the anterior vaginal wall down 
in the median line to the vaginal entrance, when a 



126 



NURSING IN ABDOMINAL SURGERY. 



little elevation of the surface will be felt, immediately 
above which the orifice of the urethra is to be 
found. If the finger be held with its palmar sur- 
face upward and resting lightly upon this elevation, 
the finger being held horizontally, a catheter 
slipped along it will enter the small orifice of the 
urethra. Should the extremity of the catheter 
seem to meet with any obstruction after its en- 
trance into the urethra, a slight withdrawal and 
rotation of the instrument will generally carry it in. 
After the catheter has been withdrawn the parts 
should be cleansed and dried. 

Fig. 31. 




Female Urinal, of China or Glass. 



Urinals. 



Notes con- 
cerning 
character 
of urine. 



Should the patient be allowed to pass her own 
water, the tin slipper urinal or the china or glass 
urinal made to fit over the vulva may be employed. 
Should there be difficulty in urination, fomentations 
applied over the vulva, or hot water in the urinal 
or bed-pan, will sometimes aid its accomplishment. 
The urine drawn should be measured and tested 
with litmus paper, and a note made on the record 
of its amount, appearance, and reaction. If there is 
anything peculiar in its appearance, that is, if it is 



NURSES DUTIES AFTER OPERATION. \2J 

smoky or bloody, or contains sediment, save it for 
the surgeon's inspection at his next visit. 

The same should be done with napkins contain- Saving of 

napkins 

ing any discharge that may come from the vagina, f ? rins P ec - 
and the fact should be reported on the nurse's 
record. 

Report also any cough ; state what kind it was Report 01 

1 J ° m cough, etc. 

— tight or loose — how long it lasted. Report hic- 
coughs. Report also the character of the sleep, as 
heavy, quiet, uneasy, or if the patient snores. Re- 
port if the patient complains of the bandages feel- 
ing tight, for inflammation is shown by the disten- 
tion of the abdomen. Report any change that may 
be seen in the patient, and send the doctor word 
concerning it, if it is at all serious. The tempera- Tempera- 
ture of the room should be kept at from 68° to yo°. room. 
It should not be allowed to vary. The patient 
should be carefully kept from all draughts, but 
thorough ventilation of the apartment should be Hygiene 

\ precautions. 

obtained. Screens carefully adjusted enable this to 
be accomplished. All discharges, wash water, etc., 
should be at once removed from the room. The 
slop-jar for the wash water should not stand in the 
sick-room, but in an adjoining room. 

After an evacuation of the bowels especial care 
should be taken to change the air of the apart- 
ment. The bed-pan should always be carefully 
covered in its removal to the water-closet. A 



128 NURSING IN ABDOMINAL SURGERY. 

newspaper or napkin may be thrown over it, if it 

has no cover of its own. 

Method of An early evacuation of the bowels is very de- 
securing an 
evacuation sirable after an abdominal section. The exact 

of bowels 

after opera- period will be dependent upon the patient's condi- 
tion. Should all go well and the patient suffer 
little from flatulence, it is not necessary to make 
any effort to have the bowels moved before the 
third day.* At that time means should be taken to 
have a movement with as little straining as possible. 
A rectal injection of a gill of cotton-seed or sweet- 
oil with a tablespoonful of turpentine may be given, 
and should be retained, if possible, about two hours, 
when a soap-and-water injection may be given. 

A very good method of securing a movement is 
by the enema composed of Epsom salts, oil, tur- 
pentine, and glycerine, combined with water, which 
has already been mentioned in the chapter on 
Preparation of the Patient. 

This enema is almost always followed by an 
immediate evacuation of the bowels. 

After this has been secured, any irritability of 
the bowel that may ensue may be allayed by the 
injection of about I gill of warm water containing 

* If the case has been one of resection of the bowels, or if there 
has been considerable bowel- stitching, no rectal injections should be 
given without express direction of the surgeon. Liquid food alone 
should be used for at least eight to twelve days. 



NURSES DUTIES AFTER OPERATION. 1 29 

a little table salt in solution. This is to be re- 
tained. 

Should enemata fail to secure a satisfactory evac- Adminis- 
tration of 
uation, salts may be administered by mouth. A salts by 

J . J mouth. 

teaspoonful or two of Rochelle salts may be given 
dissolved in a tablespoonful of hot water, and fol- 
lowed by a few sips of hot water. This dose may be 
repeated every hour, should the patient retain it, 
until from four to six doses have been taken or the 
bowels feel like moving. This followed by the use 
of a simple soap-sud enema will, as a rule, have the 

Fig. 32. 




Feeder. 

desired effect. The salts are best administered in 
this* concentrated form when it is desired to secure 
prompt effect. The nauseating effect of the dose 
may be avoided by a little circumspection in its ad- 
ministration. The solution of the salts should be 
placed in one feeder, and the hot water to be 
sipped in a separate feeder. The patient should 
be directed to put the spout of the feeder as far 
back in her mouth as she can, and to swallow the 
salts quickly, not allowing any to touch the tip of 
the tongue and tr;e lips, where the sense of taste is 
9 • 



I3O NURSING IN ABDOMINAL SURGERY. 

strongest. She may follow this immediately with 
the sips of hot water from the feeder on hand. The 
nurse should place her hand beneath the pillow and 
slightly raise the head of the patient in giving her 
anything to swallow. A napkin should be placed 
beneath the chin to prevent spilling on the clothing. 
This rule for administration should be followed in 
giving food as well as medicine. 
Use of The use of the bed-pan involves considerable 

bed-pan. x 

Methods of r isk to the patient unless great care is used in lift- 

employing. * ° 

ing her. Particularly is this true in cases of hys- 

Fig. 33. 




Slipper Bed-Pan. 

terectomy, when there is greater danger from the 
occurrence of hemorrhage or from formation of 
clots in the blood-vessels. The nurse should not 
attempt to perform this duty alone, unless she is 
fully equal to lifting the patient without jarring. 
Should the patient be slight and of light weight, 
the nurse may place one arm under the patient's 
knees, slightly lifting the hips. With the other 
hand the bed-pan may be slipped under them. 
Should the patient be heavy, she is better lifted by 



NURSES DUTIES AFTER OPERATION. I 3 I 

placing one hand under each hip and slightly raising 
her thus from above. Another attendant can then 
slip the pan under. The same manoeuvre should 
be resorted to in removing the pan. 

Should the patient be too feeble or the nurse un- 
able to get the proper help, the tin-slipper urinal is 
a convenient receptacle to use, and will involve no 
lifting. It is well to have two of these to use inter- 
changeably, because of their small size. - 

Should the nurse not have these, she may use Pads as 

substitutes 
for bed- 
Fig. 34. P ans - 




Eureka Bed-Pan. 

pads made of newspaper and soft rags or oakum, 
which can be worked under the patient without 
any lifting, and which, after use, can be simply 
rolled up and burned. The amount and character Particul 
of the movement should be carefully recorded on ported! 
the report, as also should the fact as to the expul- 
sion of gas from the bowel at any time. 

The patient should be scrupulously cleaned after 
these movements, and the parts kept thoroughly 
dry. Especial care should be taken to see that 



ars 
to be re- 



132 NURSING IN ABDOMINAL SURGERY. 

there is no moisture under the back and that the 

skin is kept from breaking. The surface upon 

which the patient lies should be perfectly smooth. 

Prevention Wrinkles tend to produce sores. Bedsores may 

of bedsores. - 1 . _ 1 r 

develop in so snort a time as the result of pres- 
sure and moisture that a nurse must exercise the 
greatest vigilance in their prevention. Rubbing 
the back daily at least once or twice with a little 
alcohol and alum serves to harden the skin. This 
may be followed by rubbing with powdered oxide 
of zinc or starch or bismuth subnitrate as a drying 
powder.* 

When the skin has broken the treatment must be 
changed. Some ointment will be necessary to 
soothe and heal the raw surface. The alcohol and 
alum, if used, would cause pain and irritation. 
Borated or carbolized zinc ointment applied on lint 
and held on with adhesive strips will constitute the 
best dressing. A most important feature of treat- 
ment is relief from pressure. A ring cushion of 
rubber may be used for this purpose, being placed 
beneath the patient in such a way that the bedsore 
shall rest over the hole in the ring. When a rub- 
ber cushion cannot be had the nurse may make a 

* Many surgeons after the fourth day permit the patient to be 
turned on her side, supporting her back with a pillow. This 
relieves parts of pressure and helps in the prevention of bedsores. 
An earlier change of position is permitted by some operators. 



NURSE S DUTIES AFTER OPERATION. 



133 



circular cushion of the kind, filling it with soft rags 
or hair. 

Bedsores may come on any part of the body Location t 

J J r J bedsores. 

which is subjected to pressure, as the shoulder, the 
elbows, the lower part of the back, and the heels. 
The skin over the sacrum or end of the backbone 
is probably the most frequent site for such a sore. 
Skill in the management of a drainage tube is one 

Fig. 35. m 




Rubber Air-Cushion. 



of the most important qualifications on the part of 
the nurse. The methods employed by different 
operators vary somew r hat, hence the nurse must 
obtain explicit directions from the surgeon in 
charge of a case. 

The intervals may be, according to his choice, 
from once every half hour to once in twelve hours 
or more. 



Method of 
draining. 



134 



NURSING IN ABDOMINAL SURGERY. 



Draining of the tube by means of a syringe 
may be accomplished either with the barrel and 
piston syringe of glass or hard rubber, to which a 
piece of rubber tubing is attached, or by what is 
known as the hard-rubber uterine syringe with long 
nozzle. These syringes should be kept in the inter- 



Fig. 36. 



MU.,.~ u, . l=>— ©- 



■A 



Glass Drainage Tube. 

vals of use in an antiseptic solution, as 1-4000 bi- 
chloride of mercury. The sponge taken from over 
the drainage tube should be put in a weak carbolic 
solution until again wanted. A small glass graduate 
is convenient for receiving the fluid drawn from 
the tube and accurately recording its amount. 

Fig. 37. 



Glass Syringe for Draining Tube. 

In making preparations for draining, the nurse 
should first arrange the covers over the patient's 
chest and over the lower limbs, so that just the 
portion of the body covered by the abdominal 
bandage shall be exposed to view. She shall then 



NURSES DUTIES AFTER OPERATION. 1 35 

thoroughly cleanse her hands, rendering them 
aseptic and loosen the bandage and rubber dressing. 
Again washing off her hands in an antiseptic solu- 
tion, she should lay back the rubber covering of 
the tube, remove the sponge, closing over its orifice, 
placing it in a carbolized solution, and take up the 
syringe with which she is going to drain the tube. 
The rubber tubing or the nozzle is allowed care- 
fully to slip down through the glass drainage tube 
into the abdomen. If the extremity of the tube is 
felt to meet with a point of resistance, it should be 




Hard Rubber Syringe for Draining Tube. 

drawn back a little before suction is effected by 
drawing on the handle of the syringe. The syringe 
should be very carefully and slowly filled and then 
drawn out. A corner of the rubber protective may 
be thrown over the mouth of the tube until the 
syringe is emptied and rinsed out. The contents 
of the syringe may be emptied into the glass 
graduate provided. The use of the syringe is con- 
tinued until no liquid remains. The sponge is then 
squeezed out of the carbolic solution and replaced 
over the drainage tube. The corners of the rubber 



I36 NURSING IN ABDOMINAL SURGERY. 

protective are folded back over the sponge and 
pinned, and the bandage, if need be, readjusted. 
The liquid drained should be placed in a small 
labeled bottle — of which a number should be pre- 
pared before the operation — and the date and hour 
with the record of the amount drained should be 
placed on the label. This enables the surgeon to 
obtain an accurate idea of the character of the 
drainage. 

When the hard rubber syringe is used care must 
be taken not to jar the sides of the drainage tube. 
Unless the syringe works easily this is apt to be 
done. The suction also may be so strong that 
portions of omentum or bowel may be drawn into 
the tube through its perforations. 
Capillary A third method of draining is by what is known 

drainage. . . ' r . ,. 

as capillary drainage ; a twist of sterilized cotton or 
gauze is placed down into the drainage tube and 
sucks up the liquid. The dressing over the mouth 
of the tube thus becomes saturated and requires 
changing. Some surgeons like the tube cleansed 
by means of small tampons of sterilized cotton, 
carried down into it by means of a long, slender 
pair of forceps, very like the uterine dressing for- 
ceps. A new twist of cotton is then placed in the 
tube. The amount of fluid drained should be 
recorded on the nurse's report, and its character 
described each time. When the liquid becomes 



NURSES DUTIES AFTER OPERATION. 1 37 

pale, losing its bloody hue, it is pure serum, and 
the surgeon will probably desire to remove the 
tube. The nurse will need to prepare a basin con- 
taining bichloride solution, about 1-4000, for the 
doctor's hands, and another with carbolic solution, 
1-40, for the instruments (scissors and forceps) 
which may be used. A tray containing fresh 
dressings and adhesive strips should also be ready. 
When the stitches are to be removed, which is 
usually during the second week, similar prepara- 
tions should be made. 

The advisability of bathing the patient during Bathing 
her convalescence should be determined by thetion. 
surgeon. The cleansing previous to operation 
having been so very thorough, it is, as a rule, un- 
necessary to give a full sponge bath and change 
the clothing for about one week after. It would 
probably involve too much moving of the patient. 
The head, neck, chest, hands and arms may be 
sponged separately as occasion may call for it. 
The same may be done with the lower extremities. 
This is less exhausting than the general bath at 
one time. With sufficient care the patient's cloth- c . ha , ng u" g 

± of clothing. 

ing may be changed without moving her too much. 
This can only be done properly if the precaution 
has been taken to have the clothing very loose. 
In removing the night-dress and under-vest, the 
sleeves should be slipped off on one side, and the 



I38 NURSING IN ABDOMINAL SURGERY. 

arm and shoulder covered by a blanket. They 
may then be taken off the opposite side in the same 
way. The sleeves of the fresh under^vest having 
been drawn through the sleeves of the fresh night- 
dress, the two garments may be slipped on at once. 
The sleeves of one side may be drawn on and then 
those of the opposite side. An assistant slipping 
her hands under the shoulders and slightly raising 
them, the nurse may draw out the soiled clothing 
from beneath the back, and slip the neck of the 
fresh under-vest and night-dress over the patient's 
head, drawing the garments well down and smooth- 
ing out all wrinkles under the back. The sleeves 
also should be straightened, so that there may be 
no feeling of constriction under the armpit. The 
drawers may be changed without much moving, 
as it is not necessary to draw them under the back 
and fasten them. 

The abdominal bandage and dressings can be 
better managed when the drawers are allowed to 
remain as a loose covering for the limbs. The 
change of stockings involves no disturbance of the 
patient. Greater difficulty will be experienced in 
beddofh? changing the bedclothing beneath the patient. If 
the draw-sheet is kept carefully changed and the 
covers, a change of the other bedclothing may be 
deferred — unless in case of accident — until the 
second week. To change the draw-sheet, unpin it 



NURSES DUTIES AFTER OPERATION. 1 39 

from its fastenings and pin one end of the fresh 
draw-sheet, properly folded, to one end of the sheet 
to be removed. 

As the hips of the patient are slightly raised by 
the nurse, the soiled draw-sheet can be quickly 
drawn out and the new one drawn under the pa- 
tient by an assistant on the other side of the bed. 
The fresh draw-sheet may then be unpinned from 
the soiled one and its ends tucked under the mat- 
tress and pinned. 

The pillow will need to be removed, beaten, 
turned and the slips changed quite frequently. 
The comfort of the patient is greatly increased by 
an occasional turning and adjustment of the pillows. 

If two beds have been provided to be used 
interchangeably during the patient's convalescence, 
the change may be easily effected by lifting the 
patient from one bed into another. It is necessary 
to have three persons to do this without jarring. All 
three should stand on the same side of the bed, 
the tallest nearest to the patient's head, the shortest 
nearest the feet. The attendant nearest the head 
should place one arm under the patient's neck, so 
that the head may lie upon it, and gain a secure 
hold with the hand of the. same arm under the 
axilla on the opposite side of her. The other arm 
should be extended just below the shoulder blades. 

The second attendant places one arm under the 



140 NURSING IN ABDOMINAL SURGERY. 

small of the back and the other arm just below 
the buttocks. The third assistant places one arm 
under the knees and the other under the ankle. 
When all three have their arms properly adjusted, 
a signal — " Now ! " — may be given by one of them, 
and all must lift simultaneously. 

This will enable the patient to be raised without 
the slightest jar and transferred to the new bed. 
The latter should have been placed conveniently 
near, the covers folded back, and the pillow placed 
so that it will be at the right end of the bed for the 
patient's head when the nurses turn around in lift- 
ing her from one bed to the other. 

When two beds cannot be had, the least dis- 
turbance is probably produced in the changing of 
the bedclothing by unfastening the under-sheet or 
blanket and the draw-sheet upon which the patient 
lies, rolling them up from one side of the bed close 
to the patient, adjusting a fresh draw-sheet to a 
fresh under-sheet, rolling them up lengthwise and 
spreading so far as possible over the uncovered 
side of the bed, tucking them under the mattress at 
the side. The remainder of the two sheets is gath- 
ered into a roll and carried close up to the roll 
made by the soiled clothing. If the patient can be 
turned on her side, both these rolls may then be 
carried well under her as she turns on the opposite 
side, and in turning back she will turn over them, 



NURSES DUTIES AFTER OPERATION. I4I 

thus enabling both the soiled clothing and the fresh 
to be carried through to the opposite side and 
properly adjusted to the bed, the soiled clothing 
being removed. Should it be considered unwise 
to let the patient roll on her side, her hips may be 
slightly lifted and the rolls of soiled and fresh 
clothing drawn through by an assistant who stands 
on the opposite side. The same manoeuvre can 
be carried out with the shoulders and the lower 
extremities until the fresh clothing is properly 
arranged. 

Another method is that of drawing the patient 
well to one side of the bed on the sheet upon which 
she lies. The fresh sheets may then be placed 
over the rest of the bed and gathered into a roll 
close to the patient's side. The patient may then 
be lifted or drawn over on to the fresh sheets. The 
old sheet may be gradually removed from under 
her and the remaining portion of the fresh sheets 
unrolled and spread over the uncovered portion of 
the bed. 

The covers can be changed by spreading the fresh 
sheet and blanket over the former covering, and 
working the latter down to the foot of the bed 
beneath these, thus removing them. 

The limbs of the patient frequently become be- Massage 

i i 1 1 r r • tm f° r passive 

numbed and acne for want of exercise. Ihe nurse exercise. 
may help this by rubbing them and gently knead- 



142 



NURSING IN ABDOMINAL SURGERY. 



Necessity 
for abdomi- 
nal sup- 
porter. 



The first 
sitting-up. 



ing the muscles from time to time. It is not neces- 
sary to remove the clothing for this. There is 
generally no objection to slightly bending the limbs 
at the knees and supporting them on a pillow. 
Small pillows, 6 inches wide and 8 to 12 long, made 
of hair, are convenient for placing around the 
prtient to remove pressure and produce slight 
changes in the position which are restful. 

Before sitting up — which is usually permitted 
about the close of the third w r eek — the patient 
should be fitted with a bandage for the support of 
the abdominal walls. As a rule, this bandage 
should be worn for one year, being removed only 
at night or when the patient lies down. This is to 
prevent rupture at the site of the incision. " The 
bandage usually employed in the "Woman's Hos- 
pital" is that known as the London Supporter. 
A modification of this has been employed in cases 
of long incision reaching above the umbilicus. 
When there is not much strain upon the abdomi- 
nal walls the ordinary elastic abdominal bandage 
serves the purpose very nicely. Great circumspec- 
tion should be employed regarding the patient's 
sitting up after she has sufficiently convalesced to 
do so. 

The period at first should be short. It is better 
to lift the patient out on a sofa or reclining chair 
for a change, rather than allow her to over-exert 



NURSES DUTIES AFTER OPERATION. 



143 



herself. The surgeon should be carefully consulted 
as to the amount and character of the exercise the 
patient may take. 

The treatment of hysterectomies, both before and Hystercc- 

■' tomies. 

after operation, is the same as that of an ordinary 
section, with the additional care of the clamp. This 
should be examined very frequently. If there is 



any 



the screw must be tightened as 



Fig. 39. 




London Supporter. 

directed by the surgeon. If the dressings are 
saturated with discharge they must be changed as 
often as needed. The stitches are usually removed 
in eight to ten days. The stump sometimes re- 
mains perfectly dry until it falls off, about the 
ninth or tenth day. When there has been oozing 
and the granular tissue around the stump is not 



144 



NURSING IN ABDOMINAL SURGERY. 



healthy in appearance a frequent dressing of the 
stump may be necessary. 

A small syringe may be used for washing out 
around the stump with peroxide of hydrogen, 
bichloride solution, or such antiseptic as the sur- 
geon may direct. After drying thoroughly fresh 
strips of gauze may be packed in around the stump. 
A drying powder is sometimes used to be dusted 
over it ; as well. Thus, boric acid or iodoform 

Fig. 40. 




Elastic Abdominal Bandage. 



powder are sometimes used. The clamp usually 
needs to be tightened at every dressing. Hys- 
terectomy patients are usually not permitted to be 
turned before the twelfth or fourteenth day, and 
not then unless the surgeon directs. 

When the stump is thus treated outside of the 
abdomen the operation is said to be done by the 
extra-peritoneal method. Some surgeons drop the 
stump, and close the abdominal incision through- 



NURSES DUTIES AFTER OPERATION. 1 45 

out. In this case the nursing is more like that of 
any ordinary abdominal section. 

The general directions given in this chapter may 
be greatly modified by different surgeons. The 
nurse must be prepared to respond to the require- 
ments of the surgeon in every case. A nurse Code of 

. m ethics in 

should never let it be known that her views differ nursing. 
from those of her superior officer. It is right 
always for the surgeon or physician to plan the 
campaign in the management of a case. The nurse, 
if she serves under him, has but one duty — to obey. 



10 



CHAPTER XII. 

MANAGEMENT OF COMPLICATIONS, 
signifi- Rise of Tempei'ature. — This symptom always 

cance of rise . . - 

of tempera- should cause anxiety alter an operation, especially 
when the temperature exceeds 102° Fahr., for it is 
so frequently the indication of blood-poisoning in 
one or another form. The rise, however, may be 
due to some other cause, as a cold, bronchitis, ague, 
or it may denote the approach of a menstrual 
period, or may accompany a discharge from the 
uterus, which is not infrequent a few days after 
operation upon the pelvic organs. Extreme excite- 
ment may similarly produce an elevation of the 
temperature for a time. The treatment of this 
fever must depend largely upon the cause. 

Means for When the temperature rises above 102 and 

reduction L 

of tempera- there is a similar increase in the pulse, some means 

ture. r 

should be taken for its reduction. An ice-cap 
may be placed upon the head and should be kept 
on until the temperature has steadily gone down, 
remaining below ioo°. The face, hands, and wrists 
may be frequently sponged with cold water. Wet- 
packing is sometimes employed where the temper- 

146 



MANAGEMENT OF COMPLICATIONS. I47 

ature keeps very high notwithstanding the ice- 
cap. 

The arms may first be packed in wet towels, 
wrung out in ice-cold water, and kept moist by 
water squeezed upon them from a sponge. The 
lower extremities and the chest may require the 
same treatment, if the application of cold to the 
arms fails to reduce the temperature. A rubber 
protective will need to be slipped under the patient 
when this treatment is carried out, to prevent 
wetting of the bedclothing. 

An ice-bag is sometimes directed to be placed 
over the heart for the reduction of temperature. 
When these means are employed the pulse and 
temperature must be frequently taken, as great Sudden de- 

1 L J ° pression 

depression may occur suddenly. The necessity for { ™™ o * v o f [ ~ 
keeping a patient very still will prevent the use of cold - 
the fever-cot in the early days after operation. Fever . cot- 
Later, however, it may be employed. No heroic 
measures, such as the above, should, however, be 
employed without the full sanction of the surgeon. 
The use of antipyretic remedies will also be 
directed by him. 

The ice-cap ordinarily employed in this country i ce -ca P . 
is a simple rubber bag, which is filled one-third full 
of pieces of ice about the size of a walnut. All air 
should then be squeezed out of the bag and a piece 
of string fastened securely around the neck. The 



I48 DISEASES OF WOMEN. 

bag is then placed on top of the patient's head, 
a single layer of muslin or toweling intervening 
between them. If the bag is filled more than one- 
third full it will not adapt itself well to the shape 
of the head. Two bags should be in use at the 
same time, so that the nurse may have one to 
immediately replace the other when refilling of the 
bag is necessary. The ice melts so fast when the 
fever is high that the bag will probably need refill- 
ing about every 20 minutes or half hour. It is 
utterly useless for the purpose of reducing tem- 
perature after the ice has melted. 
Noiseless The nurse will need to have ice close at hand 

method for 

cracking for the purpose. A block wrapped in flannel and 
kept in a covered vessel in a cool part of the room, 
or in the adjoining hall, will enable her to keep up 
this application without much difficulty. With a 
large steel pin and with the piece of ice wrapped in 
a cloth the nurse may noiselessly break off the 
pieces required for filling the cap. The pin pressed 
firmly into the ice will cause it to separate into 
pieces, which can similarly be broken into smaller 
pieces if desired. When the rubber ice-bag cannot 
be had, a pig's bladder, obtained at a drug store for 
ten cents, serves the purpose very well, although it 
is more perishable. 

Leiter's Pliable metal coils, through which cold water 

may be made to circulate continuously, are some- 



ice 



tubes. 



MANAGEMENT OF COMPLICATIONS. 



149 



times used for reduction of temperature. These 
are called Letter's tubes. They may be adapted 



Fig. 41. 




Leiter's Tube Cap. 

for application to various parts of the body. The 
coils forming a cap are used for application to the 
head. 



150 



DISEASES OF WOMEN. 



Method of 
application 
of ice-cap. 



Leiter's 
tempera- 
ture regu- 
lator. 



Water-coils 
of rubber. 



A broad tape fastened under the chin holds the 
cap to the head. A reservoir containing the ice- 
water is placed above the level of the patient's 
head and is connected by a piece of rubber tubing 
with the coils. A similar tube connected with the 
other end of the coils is placed in a receiving vessel 
on the floor. A slight suction made on the lower 
tube either by the mouth or by means of a barrel 
and piston syringe, establishes, the siphon action. 
When the lower vessel is nearly full the position 
of the two vessels may be reversed. This continu- 
ous flow of water through the spiral cap may be 
kept up any length of time required. The water 
in the supply vessel should contain ice. 

Some surgeons use by preference Leiter's tem- 
perature regulator, a long and narrow set of coils, 
which may be bent so as to shape it to the back 
and sides of the head. It is thought that better 
results are obtained by the application of cold to 
this portion of the head. 

To mould these coils they should be bent over 
some firm convex surface, as the thigh, for, if bent 
by the hands, the coils will not lie parallel and they 
will be apt to become leaky. This regulator is 
connected in the same way as the cap with the sup- 
ply and receiving vessels. 

Thornton's ice-cap consists of a series of coils of 
stout gutta-percha tubing, joined together so as to 



MANAGEMENT OF COMPLICATIONS. I 5 I 

form a cap. The tubing is flat on the inner side, so 
that a uniformly cool, smooth surface touches the 
patient's head. At the top of the cap one end of 
the tubing is connected with a pail filled with water 
containing ice. The tubing at the lower border of 
the cap terminates in a long free end which passes 
from the side of the patient's head into a bucket 
beside the bed. 

The pail supplying the water is fitted with a top 

Fig. 42. 



Rubber Water-coil. 

which may be regulated so as to allow the water to 
flow slowly. 

As the receiving pail fills, the water may be baled 
out and returned to the pail above. The ice must 
be kept supplied in the upper pail. Care must be 
taken in the use of the cap to see that the free tub- 
ing does not bend at an angle at any point and so 
obstruct the flow or escape of water. 



152 



DISEASES OF WOMEN. 



Fever re- 
ducer. 



Septi- 
caemia. 



Peritonitis. 



Symptoms 
of peri- 
tonitis. 



Symptoms 
of septi- 
caemia. 



A device consisting of a metallic reservoir for 
ice, which surrounds the head — at a distance of a 
few inches from it — thus producing a layer of cool 
air around it, has been used to some extent in this 
country, particularly in the west. It is the invention 
of Mr. Edwin B. Magill, of South Bend, Wash- 
ington, and is said to have afforded good results in 
practice. It is called a " fever reducer" or " body 
cooler." 

Septicemia, Pycemia, Peritonitis. — Septicaemia is 
a diseased or poisoned condition of the blood pro- 
duced by absorption .of putrid matter. 

Pyaemia is a similar condition produced by 
purulent infection. 

Peritonitis is inflammation of the peritoneum. 

The relations between septicaemia and peritonitis 
appear to be very close. 

The characteristic symptoms of the latter are 
violent pains in the abdomen, increased by the 
slightest pressure, often by simple weight of the bed- 
clothes, the pulse becoming very rapid and wiry. 
The temperature is not correspondingly increased, 
although somewhat elevated. These symptoms of 
acute peritonitis may pass into a condition indicat- 
ing septic infection. 

Septicaemia generally sets in between the second 
and the seventh day, with vomiting, steady rise of 
temperature, and simultaneous rise of the pulse. 



MANAGEMENT OF COMPLICATIONS. 1 53 

The complexion becomes muddy, the expression 
dull, a dark-red flush on the cheek, spirits at first 
depressed, later apathetic. 

Condition of tongue and skin varies considerably, 
as a rule, tongue rough, red, and dry, and skin dry 
until near death. The tongue may remain moist 
and skin act profusely throughout. 

It is a bad sign when flatus does not pass from 
the bowel, as is tympanites or distention of the 
bowels with gas. Another highly unfavorable 
symptom is persistence of vomiting, especially when 
the vomited matter is no longer frothy and white, 
but becomes green or dark. 

The treatment of septicaemia is preventive rather Treatment 

, . . , . ., . ofsepti- 

tnan curative, bepticaemia when it has once set incaemia. 
is very unamenable to any kind of treatment. The 
surgeon sometimes reopens the abdomen and Ration 7 
washes it out. The nurse will need to make the 
preparations for this as nearly as possible like 
those she made for the original operation. Thor- 
ough asepis should be maintained. 

For the vomiting, if it be bilious or dark, the Washing 

1 1 rpi • out °f 

stomach may have to be washed out. This may stomach for 

vomiting. 

be done by means of the stomach pump or a piece 
of long rubber tubing fitted with a funnel. A 
weak solution of warm salt water is used for the 
purpose, being poured in through the funnel, and 
after sufficient has been introduced into the stomach 



154 DISEASES OF WOMEN. 

to fill it, as will be indicated by the retching of the 
patient, the funnel may be inverted and placed over 
a waste pail below the patient, and, the tube acting 
as a siphon, thus carries off the fluid from the 
stomach. The introduction of the stomach tube 
requires no little skill on the part of the nurse. As 
a rule the surgeon attends to the matter himself. 
Should the nurse have to do it, she should proceed 
as follows: first lubricating the outside of the tube 
with a little glycerine she places the end of it in 
the patient's mouth and directs her to swallow it. 
This movement is aided by the nurse holding the tube, 
and as it enters the oesophagus (or gullet) gently 
forcing it down the required length. A black ring 
on the tube, as it approaches the teeth, indicates the 
point at which the nurse may regard the tube as 
sufficiently introduced, the ring being on a line with 
the teeth. The funnel is then connected with the 
outer end of the tube (if one does not form a part 
of the apparatus), and the nurse standing at a 
height on a stool or chair pours in the salt solu- 
tion slowly at a temperature of from ioo°-io5° 
Fahr. The patient will need to be well protected, 
a rubber cloth being fastened around the neck. In 
withdrawing the tube it should be done as quickly 
as possible to prevent retching. Shortly after 
each washing some liquid nourishment with the 
addition of stimulants, if necessary, may be given. 



MANAGEMENT OF COMPLICATIONS. I 55 

Before the vomiting has become so excessive, or other 



measures 



before the stomach washing is attempted, it may be for control 

• of vomiting. 

found to be of advantage to let the patient sip very 
hot water containing just a pinch of salt. This 
measure has been found, as a rule, preferable to the 
use of bits of ice, especially as it affects the patient 
afterward in her ability to take food and retain it. 

The temperature, if over 102 , should be reduced, Reduction 

*■ of tempera- 

if possible, by means of the ice-cap or other appara- ture - 
tus of the kind. After the reduction of tempera- 
ture and washing out of the stomach, some cases 
of septicaemia get better, because the poison thrown 
off by means of the mucous membrane of the 
stomach is removed by the washing and not re- 
absorbed into the system. 

If flatus does not pass freely from the bowel, Enemata 

• r i • r 11 ^ or ex P u *" 

especially after the insertion of the rectal tube, sionof 
enemata containing salts, glycerine, turpentine, etc., 
may be used. Should these prove unsatisfactory, 
salts may be given by the mouth.* Because of their £f t ? Tof 
depressing effect, it is better to give such in small by mouth! 
doses, as one teaspoonful of Rochelle salts dissolved 
in a tablespoonful of water, once in an hour, until 
three or four doses are taken. 

Doran recommends for the expulsion of flatus 

* Some operators prefer calomel in small doses, -§-- T V gr., repeated 
every half hour until io to 1 6 doses are taken — as it produces less 
nausea. 



I56 DISEASES OF WOMEN. 

one-half teaspoonful of aromatic spirit of ammonia 
in a little hot water. Beef-tea or milk enemata 
combined sometimes with stimulants will be needed 
in addition to what the patient takes by mouth, for 
the treatment of septicaemia requires the support 
of the patient's strength for combating the poison, 
saline treat- Where peritonitis alone exists, especial reliance 

ment of i ' *■ 

peritonitis. j s pl ace d, in this day, upon the saline treatment. An 
early and thorough evacuation of the bowels, with 
discharge of flatus, should be obtained. The means 
employed may be the same as those above men- 

Fig. 43. 




Cradle for Supporting Bedclothes. 

tioned, doses of Rochelle or Epsom salts being 
administered by mouth, or, if the stomach is not 
retentive, by rectal enemata. 
Treatment The pain arising from the tendency to accumula- 
pain. tj on f g as j n the transverse colon and consequent 

pressure upon the diaphragm may be relieved by 
the application of warm flaxseed poultices over the 
lower portion of the chest, renewed once in two 
hours, or every hour. 

The discomfort caused by the weight of the bed- 



MANAGEMENT OF COMPLICATIONS. 1 57 

clothing may be relieved by the use of a bed- 
cradle. 

A bed-cradle can be readily improvised by means Bed-cradie. 
of a large barrel-hoop divided in two equal parts. 
The two semicircles thus produced are then fast- 
ened together in the middle with their convexities 
looking the same way. This forms a coop- like ar- 
rangement, which, placed over the patient's body as 
she lies in bed, supports the bedclothing quite as 
well as a more expensive cradle. 

Opium is but little used now in the management 
of peritonitis. The nurse would, however, think of 
using no remedy, unless the warm poultice, without 
the direction of the surgeon. The free use of salts 
has been found to afford speedy relief from pain. 

Internal Hemorrhage, — This may come about from internal 

hemor- 

a slipping of the ligature, or from vessels which rhage. 
have been severed by the breaking up of adhesions. 
The danger is greatest in the first day or two, pri- Primary 
mary hemorrhage occurring, as a rule, within 24 to rhage. 
48 hours. 

The symptoms by which the nurse will recog- Symptoms 

. . . ^ . & ofhemor- 

nize this condition are faintness, paleness, restless- rha s e - 

ness, a rapid, thready pulse. The surgeon should 

at once be sent for. The nurse can do little for this Mana s e 

ment. 

condition, excepting to keep the patient from faint- 
ing, by lowering her head and giving her stimu- 
lants in small doses, as 1 teaspoonful whisky or 



158 DISEASES OF WOMEN. 

brandy in cold water once in 10 to 15 minutes, 
stimulating respiration by inhalation of hartshorn, 
etc., until the doctor comes. So far as possible the 
nurse should arrange to have everything in readi- 
ness should the doctor suddenly decide to reopen 
the abdomen. Especially should care be taken to 
see that a supply of hot sterilized water shall be in 
readiness. 

obstruction. Intestinal Obstruction. — This may occur early or 
late after an operation. The intestines may from 
various causes be bent or constricted so as to pre- 
vent the passage of their contents beyond a cer- 
tain point. 

This obstruction may cause fatal collapse or even 
perforation of the intestines. 

o/obstmc- The symptoms are abdominal pain, constant 

tlon " vomiting, distention of the abdomen, without a 

marked rise of the temperature. 

Prevention. Much may be done to prevent danger from this 
source by proper attention to the bowels before 
operation. 

reHev?n|.° f Change in the position of the patient from one 
side to another, or inverting the patient by elevat- 
ing the foot of the bed considerably above the sur- 
face, so that the intestines are carried toward the 

do?* 1 injec ~ diaphragm; the use of the high rectal douche, 
several quarts of water being allowed to flow into 
the intestines with the patient in an inverted 



MANAGEMENT OF COMPLICATIONS. I 59 

position — any of these methods will sometimes 
straighten out the bend or loosen the constriction 
of the intestines.* 

It has sometimes been found necessary to re- 
open the abdominal wound and thus to remove the 
obstruction. 

Fcecal Fistula. — This is a small opening in some £ s s ^ ' 
part of the intestines which communicates with the 
abdominal wound, opening on the surface of the 
body, and permitting the contents of the bowel to 
pass out at this point. These openings are pro- 
duced from various causes and are sometimes very 
slow to close up. 

The nurse must exercise the greatest care in 
changing dressings as often as may be necessary 
and preventing the contaminating effect of the 
faecal matter. 

Abscesses. — These may be suture-track abscesses, Abscesses. 
or may come in the abdominal walls at a point 
whence the drainage tube was removed, or may be 
formed by morbid changes in the pedicle. The 

* In the occurrence of obstruction of the bowels the use of 
Rochelle salts by mouth every hour, with rectal enemata of soap 
and water every hour, retained as long as possible, may be sufficient 
to produce a free evacuation. It is well to combine from a half to an 
ounce of turpentine with the injection. If there is nausea and Roch- 
elle salts cannot be retained, liquorice powder, citrate of magnesia, 
calomel, etc., may be used. Poultices of flaxseed and mustard may 
at the same time be used over the abdomen. 



i6o 



DISEASES OF WOMEN. 



Symptoms 
of inflam- 



mation in 
wound. 



Throm- 
bosis. 



nurse should be quick to report any redness or 
irritation about the wound, as an abscess may thus 
be averted. When it once occurs, the abscess 
should be thoroughly evacuated and the dressings 
kept properly changed. 

Thrombosis. — By this is meant the formation of a 
clot in a vein, by which an obstruction to the 
circulation is produced. This causes a swelling of 
the limb. It is not an infrequent result after the 
removal of a simple ovarian tumor, particularly if 
it be a very large one. It is generally caused by 
the patient's attempting to walk or stand too soon, 
as at the end of a fortnight. In many of these 
cases a previous history of swelling of the limb can 

Symptoms, be obtained. Very frequently the patient simply 
complains that one leg feels bigger than the other. 
On examination the tissues over the tibia or shin- 
bone may seem swollen, but there will be no 
especial tenderness. 

Phlegmasia. Phlegmasia, — By this is meant an inflammation 
of the veins caused by a similar obstruction and the 
production of inflammation in the walls of the 

Symptoms, veins. The swelling in these cases is generally 
marked and extends to the thigh; enlarged, tender, 
cord-like veins may be felt in the groin, or under 
the knee, or elsewhere. There is apt to be con- 
siderable constitutional disturbance, fever, and 
severe pain. 



MANAGEMENT OF COMPLICATIONS. l6l 

Whenever any sign of thrombosis occurs the Manage- 

11111 i i • • merit of 

patient should be kept in the recumbent position, thrombosis 
The swollen limb should be kept warm by themasia. 
application around it of cotton or wool. Over the 
swollen, cord-like veins a warm flaxseed poul- 
tice may be placed for the relief of pain. The 
application on lint, beneath this poultice, of an oint- 
ment, made by combining equal parts of belladonna 
and iodine ointment, will often serve to allay more 
quickly the swelling and pain. The limb should 
be elevated by pillows or a fracture box, forming 
an inclined plane. The bowels should receive 
careful attention, free purgation being obtained 
by any means the surgeon may prescribe. It is of 
extreme importance to keep the limb still, even 
after the swelling has subsided. The patient must 
not be permitted to place her foot on the ground 
until the surgeon gives his full consent, for this 
complication is a most serious one, and is a cause 
for anxiety. 

Pulmonary Embolism. — This is a fatal complica- Embolism. 
tion produced by a small clot being swept through 
the current of the circulation into the pulmonary- 
artery, forming thus an obstruction to the circula- 
tion and producing instant death. Young, active 
patients, whom it is difficult to keep sufficiently 
quiet after an operation, are especially in danger 
from this cause. 



l62 



DISEASES OF WOMEN. 



Complica- 
tions. 



Parotitis. 



Cases have been reported where patients died 
suddenly from this complication days and even 
weeks after an operation, when all appeared to be 
going on well. It may occur, as a result of over- 
exertion, in any disease accompanied by debility 
or exhaustion. 

Parotitis. — Inflammation of the parotid glands, 
such as occurs in mumps, is sometimes found as a 
complication after abdominal section. In some 
cases this is simply a temporary swelling which 
disappears in a few days ; in others it may be septic 
in character, when suppuration may result, or even 
inflammation of the periosteum and destruction of 
the lower jaw. The management, if septic, will be 
that of septicaemia — supporting in character. Such 
local applications for relief of pain, etc., must be 
employed as are ordered by the surgeon. 
Palpitation. Palpitation. — Severe attacks of palpitation are 
apt to occur after abdominal section, and most fre- 
quently occur at night. It is supposed that these 
are caused by changes in the circulation, due to 
removal of a tumor, and, possibly, in large part to 
enforced lying on the back for considerable length 
of time. A half teaspoonful of aromatic spirit of 
ammonia in two tablespoonfuls of water will give 
the patient great relief. The symptom may greatly 
alarm an inexperienced nurse, but an expression 
of fright on her part only makes the patient worse, 



Causes. 



Manage 
ment. 



MANAGEMENT OF COMPLICATIONS. 163 

hence she should not allow her anxiety to be seen. 
The condition is not a dangerous one. 

Cystitis. — Inflammation of the bladder quite fre- cystitis, 
quently occurs as a complication after abdominal 
section. The patient complains of pain in the Symptoms, 
lower part of the abdomen, and feels cutting pains 
on passing her urine. Sometimes the irritation 
shows itself simply in a frequent desire to pass 
water. The urine is generally thick with ropy 
mucus and contains a considerable amount of sedi- 
ment. The difficulty of passing water in urinals Causes. 
or bed-pans in the recumbent posture is partly 
responsible for this. The more frequent cause is 
improper catheterism. The awkward use of the 
catheter, which leads a nurse to carry discharges 
from the vagina into the urethra and bladder ; or 
the use of a catheter which is not aseptic, not hav- 
ing been kept properly cleansed, are prominent 

causes for such trouble. The free use of flaxseed Manage- 
ment. 

tea or barley water, with a stoppage of the use of 
the catheter, will often be sufficient to put a stop to 
the suffering. The use of medicinal remedies in 
case of too great acidity or alkalinity of the urine 
will have to be directed by the surgeon. The nurse Testing of 

urine. 

should have a little litmus paper, which can readily 
be obtained at any apothecary's, and test the urine,- 
so that she can report its reaction to the surgeon. 
If the blue litmus paper is turned a decided red 



164 DISEASES OF WOMEN. 

when dipped in the urine, the secretion is too 
acid ; if the pink litmus be turned blue we have 
an alkaline urine. 
Washing it is sometimes necessary, for the comfort of the 

bladder. patient, to wash out the bladder with some soothing 
solution, as a saturated solution of boric acid. The 
apparatus necessary for this is simply a soft rubber 
Nelaton catheter, a small funnel which can slip into 
its outer end, and a small pitcher containing the 
solution to be used in the process. The solution 
should range in temperature from ioo°-i05° Fahr., 
not higher. The patient being placed on the pan, 
the urine contained in the bladder is first entirely 
drawn off by means of the catheter ; its outer 
extremity is then elevated, the funnel fitted in and 
the solution allowed to flow gently into the bladder 
until the patient experiences a sense of distention 
of the bladder ; the funnel may then be inverted 
over the bed-pan, and the liquid allowed to flow 
out. This cleanses the bladder of all debris. It 
may then be refilled to distention, and again emp- 
tied so long as the liquid does not come away clear. 
After the liquid becomes clear, the bladder may be 
refilled with the solution and the catheter with- 
drawn, allowing the solution to remain in the 
bladder for its medicinal effect upon the inflamed 
mucous membrane. The patient will probably 
retain this some little time before passing it. 



MANAGEMENT OF COMPLICATIONS. 165 

The return or double-channel catheter is some- Return 

. . catheter. 

times used in preference to the apparatus just 
described, but in my opinion is not so convenient. 
The nurse should never attempt washing out the 
bladder without the surgeon's instruction and sanc- 
tion. 

Occasionally the nurse is directed to place warm 
flaxseed poultices over the lower part of the abdo- Poultices 

i* 1111 •• • tm • for relief of 

men for relief of the bladder irritation. This can- pain. 
not always be resorted to, because of the close 
proximity of the wound to the part. Should the 
poultices be ordered, the nurse should see that they 
are changed with sufficient frequency to keep them 
warm, as they are worse than useless when cold. 
A poultice of ordinary size, if well covered with 
oiled silk and a layer of cotton or wool, will retain 
its warmth about two hours. 

Improper Action of Kidneys. — For this complica- 
tion use dry heat — keep the patient as warm as pos- 
sible and sustain the strength with stimulating in- 
jections, alcohol baths, etc., and such medication as 
the doctor may prescribe. Keep the patient warmly 
wrapped. 

Tetanus. — This is a disease which consists in a Tetanus 
permanent contraction of all or some of the muscles. 
Its characteristics are closure of the jaws, difficulty 
or impossibility of swallowing, rigidity of the limbs 
and trunk. The trunk is sometimes curved for- 



1 66 



DISEASES OF WOMEN. 



Trismus. 



ward (emprosthotonus), sometimes backward (opis- 
thotonus), and sometimes to one side (pleurotho- 
tonus. 

When tetanus is confined to the muscles of the 
jaws it is called trismus. 

It is a most formidable condition. This disease, 
although rare after abdominal section, may occur, 
as after other operations. 
Treatment. Treatment is of little avail. It must be treated 
here as where it complicates other diseases, that is 
by bloodletting, cold and warm bathing, anaesthe- 
tics, opiates, etc., according to the surgeon's direc- 
tion. The nurse's duty is to report the first indica- 
tion of such an occurrence. 

The surgeon may desire to reopen the abdomen 
for examination of the stump for any special source 
of irritation. 

Passage of Ligatures. — When the pedicle of the 
tumor suppurates, the ligatures may be discharged 
through the bladder, or through the bowels, or 
through an abscess of the abdominal wall. This 
may occur at varying lengths of time after the 
operation. 

Menstruation after Abdominal Section. — A "show" 
of blood frequently occurs a few days after opera- 
tion, particularly after ovariotomy or operation upon 
the uterine appendages. There is almost always 
some rise in temperature accompanying this " show" 



Passage of 
ligatures. 



Menstrua- 
tion after 
abdominal 
section. 



MANAGEMENT OF COMPLICATIONS. 1 67 

and frequently depression of spirits. The pulse, 
too, may rise considerably. This flow may last 
from a day or two to a week or two, varying in 
quantity. The surgeon will sometimes direct the 
use of vaginal douches of boracic acid or bichloride 
solution — once or twice daily — usually after the 
flow has ceased. 

The patient must always be advised to keep very Necessity 

, -\ r 1 r r ^ or rest - 

quiet during the first three or four periods after an 
abdominal section, particularly for disease of the 
pelvic organs, as there may be hemorrhage from 
the stump. 



CHAPTER XIII. 



THE PELVIC ORGANS IN WOMEN. 



External 
and internal 
genitalia. 



,Mons 
veneris. 



Labia 
majora. 



Nymphse. 

Clitoris. 
Vestibule. 



Meatus 
urinarius. 



These are divided into the external and internal 
organs of generation. The external organs are 
also called the " pudenda" or " vulva." 

Immediately above the pubic bone, or anterior 
border of the pelvis, is a cushion of fat, usually 
covered with hair. This is called the. " mons ve- 
neris." 

On each side of the opening of the vulva are the 
labia majora, or large lips. Lying beneath these 
and concealed by them in young women, are tw T o 
thin folds of flesh, named the "labia minora" or 
" nymphse." They join together above, and at 
their junction is a small projecting body called the 
"clitoris." 

The small triangular space between the clitoris 
and the nymphse is the vestibule. 

The opening of the urethra (the " meatus urina- 
rius"), through which the urine escapes from the 
bladder, is in the middle of the lower border of the 
vestibule. 

It is very important that the nurse should know 
1 68 



THE PELVIC ORGANS IN WOMEN. 



169 



the exact position of the meatus urinarius, as she 
will frequently be called upon to pass the catheter. 
Below the vestibule is the orifice of the vagina, Vagina 



Fig. 44. 




'3t---.:-- 


5 ■ - 


8 
9 

7 


" _____ 


3 
8 

1 




2 






I. The right large lip. 2. The fourchette. 3. Right nympha. 
4. Clitoris. 5. Urethral orifice. 6. Vestibule. 7. Orifice of va- 
gina. 8. Hymen. 10. Mons veneris. II. Anal orifice. 



the canal leading to the uterus or womb. In vir- 
gins a delicate membrane, usually crescentic in 
shape, blocks the entrance to the vagina. 



170 



DISEASES OF WOMEN. 



Hymen. 



Carunculae 

myrti- 

formes. 



Perineum. 



The hymen is usually ruptured at marriage, but 
a woman may be a virgin, yet have no hymen. 
In some cases it persists even after marriage and 
offers an obstruction at childbirth. A woman who 
has borne children has a few fleshy projections at 
the orifice of the vagina, the only remains of the 
hymen, called the " carunculse myrtiformes." Be- 
tween the vulva and the anus is a mass of flesh, 
the space on the surface measuring iy£ inches in 
length. During the birth of the child this becomes 
greatly distended, and thins like rubber. This is 
the perineum. It may be torn during labor to a 
greater or less extent ; sometimes it is completely 
torn into the bowel. 

That part of the perineum in the virgin which 
forms the posterior border of the vulvae, is called 
Fourchette. the a fourchette." It is merely a fold of skin, and 
is almost always torn in a first labor. 

Behind the perineum is the anus, or orifice of 
the rectum — the lower part of the bowel. 

The vagina is a canal connecting the external 
with the internal organs of generation. 

The uterus is at the top of the vagina. In front 
of the uterus is the bladder, and behind and to the 
left, the rectum. 

A secretion of mucus keeps the vagina moist. 
There should, however, be no discharge in a per- 
fectly healthy woman. - During pregnancy, and as 



Anal 
orifice 



Vagina. 



Uterus. 



THE PELVIC ORGANS IN WOMEN. 



171 



a result of ill health or local inflammation, the nat- 
ural secretion may be greatly increased, and the 
patient is then said to have " the whites." 

In labor the discharge is very greatly increased, 
so as to aid the birth of the child. 

The uterus is a pear-shaped organ, 3 inches in 
length, \y 2 inches in breadth, and about I inch in 




Cavity of the Uterus and Fallopian Tubes. 

A. Superior border or fundus of the womb. B. Cavity of the 

womb. C. Cavity of the neck of the womb. D. Canal of the 

Fallopian tube. E. The fimbriated extremity. F 9 F. The ovaries. 
G. The cavity of the vagina. 



thickness. It weighs a little over an ounce in its 
normal condition in a virgin. After child-bearing 
it remains larger and heavier than before. That 
portion of the uterus which communicates with the 
vagina is called the neck, or cervix. The chief por- Cervix, 
tion of the organ above this is called the body, and 



172 



DISEASES OF WOMEN. 



Fundus. 



Os uteri. 



Fallopian 
tubes. 



Fimbriated 
extremity. 



Ovaries 



Broad 
ligaments. 



the rounded upper surface the fundus. The open- 
ing in the cervix which communicates with the va- 
gina is called the " os uteri." That portion of the 
cervix in front of the os uteri is the anterior lip, 
while that part which lies behind is the posterior 

up. 

The Fallopian tubes are two canals which pass 
from each side of the upper portion of the uterus. 
They are from 3 to 4^ inches long and will admit 
the passage of a bristle. 

Each ends in a trumpet-shaped opening sur- 
rounded by a fringe of small projections called 
" fimbriae." This is called the fimbriated extremity. 
When the ovum (or egg) escapes from the ovary, 
it is received by the Fallopian tube and reaches the 
cavity of the uterus in this way. 

The ovaries are two small flattened bodies about 
and inch long and half an inch thick. They lie 
about an inch from the fundus of the uterus on 
each side, in the folds of the broad ligament. The 
broad ligaments are folds of peritoneum, a thin 
glistening membrane which covers the uterus and 
all the pelvic organs, and by means of which the 
uterus is suspended in the pelvis. The bladder 
and rectum being covered with the same tissue, 
there is an intimate connection between the three, 
so that if one is deranged the others are likely to 
be so also. * 



THE PELVIC ORGANS IN WOMEN. 1 73 

The breasts are considered as belonging to the Breasts, 
external organs of generation. They are two 
glands situated on the front of the chest, one on 
each side of the breast bone. They vary in size 
and shape in different women, and during preg- 
nancy they enlarge greatly. 

They secrete milk for the nourishment of the 
child. The nipple at the apex of the gland is a 
conical-shaped projection. The milk ducts all come 
toward it from the different parts of the breast and 
open on its surface. The areola is a pink or brown 
circle which surrounds the nipple. 

There is an intimate connection between the 
breasts and the uterus. Pain in the breast may be 
the result of disease of the uterus. The secretion 
of milk is called " lactation!' 

Menstruation is a bloody discharge from the J£ e n nstrua 
uterus every month. It begins usually about the 
age of fourteen and recurs every month except 
during pregnancy or while a woman is nursing. It 
ceases at the change of life or menopause (between 
forty-five and fifty). 

At puberty, that is when this function first appears, Puberty. 
the girl becomes a woman, the breasts enlarge and 
the pelvis increases in size. The organs of gene- 
ration become ready to perform the functions of 
reproduction. 

The menstrual flow recurs every twenty-eight 



174 DISEASES OF WOMEN. 

Periodicity days and lasts about four days. The quantity of 
struai flow, blood lost at a period is from four to eight ounces. 

Quantity of T ~.. rr . . . . ^. 

menstrual Different women vary much in this respect. The 
discharge is blood mixed with mucus. Its color is 
dark red. Any peculiarity in color or the appear- 
ance of any clots in the discharge will need to be 
noticed by the nurse, and the discharge kept for 

pacing the doctor's inspection. There is usually a feel- 

symptoms. j n g. Q f discomfort at the menstrual period, with 
headache, pains in the back, breasts, etc. These 
symptoms are more severe in some women than in 
others. 

Conception. Conception most usually takes place immediately 
or very soon after a period. This is not an invari- 
able rule, as women have become pregnant before 
menstruation has been established or even after the 
menopause. They may also become pregnant 
while nursing. 

A nurse is so often questioned on these points 
that it is well for her to have information concern- 
in them. Always endeavoring to discourage the 
inquisitiveness of mere prurient curiosity, she 
should aim to give wise counsel concerning matters 
of which her patient may hesitate to speak to her 
physician. In doing so, the nurse should, however, 
speak to the physician of any matters of import- 
ance concerning the condition of the patient, which 
she may thus learn, and ask his counsel as to the 
advice she should give. 



CHAPTER XIV. 

DISEASES OF WOMEN. 

By this term is meant, in particular, the diseases Definitions 
affecting the organs peculiar to women, as the 
external and internal genitals. The term may be 
made to include diseases of the rectum and bladder, 
which are closely associated with these organs, 
and also diseases of the breasts. 

In investigating the causes of pelvic disease, J auses of 

& & r > disease. 

we find that ignorance on the part of women is 
largely responsible for their great number and fre- 
quency of occurrence. Civilization, so called, has 
laid certain restrictions on healthful living, and 
established fashions which are directly opposed to 
physiological laws, and which tend to produce 
abnormal conditions. 

Some of the most common causes of pelvic 
diseases are — 

i. Neglect of physical exercise, especially in the 
open air. 

2. Improper clothing. 

3. Improper and insufficient food. 

175 



I76 DISEASES OF WOMEN. 

4. Habitual neglect of the functions of the bowels 
and bladder. 

5. Imprudence during menstruation. 

6. Overstrain of the nervous system by too much 
excitement, unwholesome reading, unwholesome 
companions, unwholesome thought. 

7. Marriage when disease of the genital organs 
exists. 

8. Lack of prudence in the marital relations. 

9. Prevention of conception. 

10. Induction of abortion. 

11. Neglect of injuries due to parturition or child- 
birth. 

Within recent years it has become more custom- 
physicai ar y f or WO men to take physical exercise: girls may 

exercise, J ■*■ J ° J 

andffesh P^ a y tennis, row, ride on horseback, and take long 
air - walks, without being regarded as unladylike. 

Even yet, however, so much of woman's work lies 
within the walls of her home that she is apt to be- 
come careless on this point, to lose all taste for out- 
door exercise and to confine herself to heated, illy- 
ventilated rooms. For amusement she takes up 
reading, music, drawing, or some other light task, 
which keeps her sitting, so that her muscular system 
becomes weakened. It is not only bodily exertion, 
however, that she needs, but the exhilarating effect 
of sunlight and fresh air — the mental relaxation 
which comes from out-door exercise. Every 



Lack of 



SUGGESTIONS IN HYGIENE. 1 77 

healthy woman should walk at least two miles daily 
and observe the manner of walking which will serve 
to exercise her muscles to their fullest extent and 
thus stimulate the circulation — a brisk walk with 
head held erect and the shoulders thrown well back, 
so that the lungs may, at the same time, be well filled 
with air. So important is it to keep the general cir- 
culation in good condition that in the management 
of conditions of local congestion or inflammation 
which interfere with active exercise, the use of pas- 
sive motion by the Swedish movement cure, mas- 
sage, Turkish baths, or frequent salt baths com- 
bined with calisthenics are much resorted to in 
treatment. 

In the style of clothing worn by women the last improper 

J & J clothing. 

few years have made a great change. It is no 
longer necessary for a woman to dress injuriously to 
health in order to be well dressed. The patterns 
of the Jenness-Miller Reform Dress Wear and 
other dress reform systems aim to correct former 
unhygienic requirements. The constriction of the 
chest caused by the use of corsets ; pressure and 
partial paralysis of the abdominal and chest muscles 
by tight and heavy clothing ; the unnatural position 
of the pelvic organs as a result of such pressure, 
were the inevitable result of former fashionable 
modes of dressing. To a certain extent these 
deleterious styles still prevail, and women who are 



I78 DISEASES OF WOMEN. 

ignorant of physiological laws, by adopting such 
fashions keep them up. Intelligent women who 
desire to live long and happily, and to provide a 
future of physical comfort for their children, are 
ready to adopt the reform systems which correct 
these errors. 
Sefsfng? The clothing should all be supported from the 

shoulders, and should be so constructed as to 




Equipoise Waist. 

allow perfect freedom of every part of the body. 
The use of the Jenness-Miller model bodice or 
Equipoise waist — to which the skirts and under- 
garments may all be fastened, is an excellent 
method of attaining this purpose. The jersey- 
fitting union undergarment of silk or merino may 
be worn in addition, if desired. Divided skirts or 
leglettes made of muslin or, in winter, of flannel, 



SUGGESTIONS IN HYGIENE. . 1 79 

cashmere, or silk, etc., make a very comfortable 
undergarment and enable one to dispense with 
underskirts. The skirts of dresses may be fast- 
ened, by means of buttonholes in the waistband, to 
the Equipoise waist or model bodice. If heavy, 
however, it is best to have them fastened to a 
separate waist, modeled after the pattern of the 
child's petticoat waist with armholes. Were these 
methods more strictly observed in the dressing of 
growing girls, fewer women would be found suffer- 
ing from displacements of the uterus and ovaries 
and the many pelvic diseases which follow in their 
wake. 

Improper 

Poor blood as a result of poor eating is so com-a nd . 

L ° insufficient 

mon an accompaniment of uterine disease that we food - 
must often regard it as the chief cause of the ab- 
normal condition. The muscular tone of the pelvic 
organs is decidedly affected by want of sufficient 
nutrient material, and displacements are thus readily 
produced. It is not only important that a certain 
amount of food shall be taken daily, but the food 
should be such as is capable of making blood of 
good quality. It should be nourishing and digest- 
ible. Pastry and sweets should be avoided or taken 
only in small amount. The meals should be so 
regulated that a heavy meal shall not be taken at 
night when the digestive processes are least active. 
Milk, eggs, meat, bread, fresh vegetables and fruit 



l8o . DISEASES OF WOMEN. 

should be properly combined in forming a whole- 
some dietary. 
Habimai Habitual constipation and lack of attention to 

neglect ^ x 

of the the bladder are frequent causes of uterine displace- 

functions of * l 

J\°*£ lsand ment. The uterus lying, as it does, between the 

bladder. / fc>> » 

bladder and bowel is readily affected by the condi- 
tion of either. Not realizing this, women are often 
led, from motives of modesty, to neglect attending 
to their demands, and thus they acquire a habit of 
toleration which is most injurious. The large hard 
masses of fecal matter which remain not only for 
days, but often for a week at a time in the rectum, 
interfere with the circulation in the pelvic organs, 
and produce displacements which are sometimes 
most unmanageable, in fact, incurable. A full 
bladder acts similarly by pressure on the anterior 
surface of the uterus, and, in addition, the retention 
of urine may become a source of disease both of 
the bladder and of the kidneys. 
imprudence Violent or excessive physical exercise is to be 
stmation. avoided during menstruation, because of the con- 
gested condition of the pelvic organs at this time. 
For the same reason precaution should be taken 
regarding undue exposure to cold, or sudden chill- 
ing from imprudence in bathing. The suppression 
which is often thus induced is a result of over- 
congestion and a direct cause of uterine and ovarian 
disease. Excessive emotion frequently produces 



Nervous 
overstrain. 



SUGGESTIONS IN HYGIENE. l8l 

similar results. Hence scenes of excitement should 
be avoided at such times. Exposure due to insuf- 
ficient clothing, the low neck and bare arms of 
fashionable evening dress, have frequently been the 
cause of life-long ill health. 

Tension upon the nervous system is partly the 
result of our fast modes of living — the competition 
of the day which makes each one strive to surpass 
his neighbor. It is also largely the result of in- 
heritance, education, and habit. This unfortunate 
combination of circumstances offers a formidable 
resistance to one's efforts to gain self-control. 
Determination and continued effort, however, ac- 
complish much in the formation of habits which 
give one a capacity for endurance. The diversion 
of the mind into wholesome trains of thought and 
study will serve to hold in abeyance the impulses 
of one's nature. Sources of excitement, such as 
persistent novel-reading, a frequenting of places of 
amusement, extreme indulgence in society gather- 
ings, are to be avoided. 

One of the greatest difficulties a nurse will meet 
will be the management of a mind thus diseased, 
and infinite tact and skill will be necessary to 
enable her to steer the thoughts and purposes of 
her patient into safe channels. The nurse must 
make the moral atmosphere of the sick-room. 

Marriage when disease of the genital organs Marriage. 



182 



DISEASES OF WOMEN. 



Lack of 
prudence 



exists is another frequent source of disease. The 
reason for this may clearly be seen. Organs 
already the seat of a morbid process are only more 
extensively irritated by the increased congestion 
thus induced. 

Lack of prudence in the marital relations in a 
similar way may cause disease. Periods during 
which the pelvic organs are in a state of congestion 
from natural or abnormal causes, should be periods 
of rest. Thus during the menstrual period and 
for a short time before and after the same, during 
pregnancy and the lying-in, the pelvic organs 
demand rest. 

Prevention of conception and induction of abor- 
cepdon and- tion act in the same way as the last two causes 

induction J 

of abortion, mentioned, that is, they result in conditions of 
excessive congestion and even active inflammation 
which not only bring about diseased conditions 
which cause much suffering, but which endanger 
the life of the patient. Blood-poisoning is not an 
uncommon result of efforts at inducing abortion. 
Neglect of injuries due to childbirth is a most 

Lacerations, erosions, 
etc., frequently pass unnoticed by the physician. 
The nurse in cleansing her patient after delivery, 
has an opportunity to observe them, and should be 
careful to call the attention of the physician to their 
existence. This should always be done elsewhere 



Prevention 
of con- 



Injuries due 

to child- & 

birth. common cause of disease 



SUGGESTIONS IN HYGIENE. 1 83 

than in the presence of the patient. The best time 
to. repair these injuries is as soon as possible after 
their occurrence. Should their repair for various 
reasons be put off for a time, they should not be 
forgotten, but the advice of a competent physi- 
cian obtained as to the probability of their inducing 
chronic forms of pelvic disease. 



CHAPTER XV. 

GENERAL NURSING IN PELVIC DISEASES. 

From what has been said in the preceding chap- 
ter it will be seen that it is seldom that a nurse will 
be called upon to take charge of a case of pelvic 
trouble, that she will not find the patient suffering 
of 'pdv^ 5 from many morbid conditions. She will have poor 

disease. 111 1 . ,. 

blood, poor circulation, poor appetite, poor diges- 
tion, poor nerves. She will suffer from cold hands 
and feet, indigestion, constipation, headache, back- 
ache, sleeplessness, and extreme nervousness. The 
nurse will have abundant opportunity to exercise 
all that ingenuity and skill can devise to meet this 
array of ills. 
ment age " The physician's directions will include — 

1. Attention to diet. 

2. Stimulation of the circulation and respiration 

by bathing, exercise, etc. 

3. Regulation of the sleep. 

4. Regulation of the functions of the body. 

5. Regulation of the clothing. 

6. Treatment of local conditions of disease. 

7. Mental qccupation. 

184 



GENERAL NURSING IN PELVIC DISEASES. 1 85 

The patient will probably be placed upon " forced Forced 

feedinsr. 

feeding ; " that is, she will be made to take a cer- 
tain amount of nourishment in the twenty-four 
hours. The food will be prescribed by the physi- 
cian according to the especial requirements in each 
case. The milk diet is frequently used where di- 
gestion and assimilation are poor. Beef-tea is 
sometimes used, alternating with milk ; a gill or a 
gill and a half of each may be given once in two 
hours. It may be necessary to have these pepton- 
ized. Should the liquid milk diet tend to produce Milk diet, 
flatus it may be of advantage to thicken the milk 
with rice flour, wheat flour, crumbed bread, etc. ; 
junket, or milk thickened with rennet, is often 
liked by many patients, and is easily digested ; 
farina, wheat germ, egg custard, and similar prep- 
arations, if well prepared, may be quite readily di- 
gested and help to vary the monotony. The chief 
objection to the milk diet arises from its monotony ; 
the patient gets to dislike it so that it is almost im- 
possible to get her to take sufficient nourishment. 
By a little management the nurse can put off this 
period. A drop of black coffee, or extract of va- 
nilla in a glass of milk, or a little salt, will so change 
the flavor as to make it more palatable. The addi- 
tion of lime water, a tablespoonful or two in a glass 
of milk {ij4 gills) is sometimes necessary to aid 
the digestion. 






1 86 DISEASES OF WOMEN. 

Mixed Where the patient does not need to be kept on 

liquid food, or when the dietary can be increased, 
fresh animal food can be given three times a day, 
and as much other nutritious food as the patient 
can take — stale bread, rice, eggs, crushed wheat, etc. 
Between breakfast and dinner, dinner and supper, 
and on retiring at night, the patient should take a 
tumblerful of milk or a cup of beef-tea, or of beef, 
mutton, or chicken broth. 

feeding Should the patient be entirely on liquid diet she. 

should receive nourishment about once in three 
hours through the night. 

A very anaemic patient may need to be fed once 
or twice through the night, even when taking a 
mixed diet. 

Animal Where meats are not well digested, it has been 

found, in our experience, that the raw-beef sand- 
wich, made by scraping a tender piece of raw 
beefsteak with a knife, salting and spreading the 
pulp thus obtained between thin slices of bread or 
toast, offers a convenient and palatable form of ad- 
ministering animal food. Beef being the most nu- 
tritious of the animal foods, a tender piece of broiled 
beefsteak, or a slice or two of rare roast beef, or the 
raw-beef sandwich, should frequently form a part of 
the meal. All fried foods, pastry, and sweet des- 
serts should be avoided. When the stomach is 
very irritable, and only small quantities of food can 



GENERAL NURSING IN PELVIC DISEASES. 1 87 

be taken, freshly expressed beef-juice gives a highly 
concentrated and nutritious food, one tablespoonful 
of this representing the nutritive properties of about 
one-quarter of a pound of beef. 

Bathing. — A sponge bath of warm water strongly ^ i ^ atimi 
impregnated with salt should be taken each morn- 
ing on rising, and, if possible, at night on retiring. 
A teacupful of ordinary table salt may be added to 
the basin of warm water. Rock salt may be ob- 
tained for bathing purposes, and kept on hand if 
preferred. This sponguig should be followed by a 
brisk rubbing with a coarse towel ; the knitted tape- 
towel is the best, or a bathing glove of coarse 
material, or a flesh brush may be used. 

Calisthenic exercises with dumb-bells, rods, etc., Exercise. 
or the practice of Swedish movements from ten to 
fifteen minutes following each bath are of great 
value. 

Any active exercise to be taken by the patient 
must be controlled by the physician. If the pa- 
tient is unable to take such, the use of massage and 
tonic electricity must be called into play. A good 
nurse should understand the methods of applying 
both massage and electricity for their tonic effect. Rules for 

1 • • 1 • 1 exercise. 

Neither should be given within two hours of a full 
meal, either before or after. Neither should be 
given when the patient is very tired, nor should the 
application be made to exhaustion. An hour's 



1 88 DISEASES OF WOMEN. 

massage is the average length of time for a patient 
who has learned to take it without growing tired. 
The application of electricity, that is by means of # 
the faradic battery, will require from twenty minutes 
to half an hour for the entire body. The patient 
should be kept well protected from exposure dur- 
ing these applications. 

A patient who is entirely dependent upon passive 

Massage, exercise and who is not too weak, may have one of 
these applications in the morning and the other in 
the afternoon or at bedtime. When the patient suf- 
fers from sleeplessness, the massage given at bed- 
time has often a most calming and healthful effect, 
serving to induce sleep. In any case, at whatever 
time of day these applications may be given, the 
patient should remain quietly at rest in bed for half 
an hour to an hour after the treatment, and if pos- 
sible take a nap. 

sleep. Sleep. — A patient in this generally run-down con- 

dition demands a great deal of sleep, and should 
try to obtain at least nine hours every night, besides 
the hour in the daytime. The habit of retiring 
early should be cultivated, as sleep is far more re- 
freshing when thus taken in the early hours of the 
night. The patient should be asleep at least by 
nine o'clock. She will then be prepared for early 
rising and the enjoyment of the hours of the day 
which are most invigorating. 



GENERAL NURSING IN PELVIC DISEASES. 1 89 

Clothing. — Something of what is required in this Rules 

• i* regarding 

connection has already been stated in the preceding clothing, 
chapter. The clothing should be loose, light, and 
supported from the shoulders. It should also be 
sufficiently warm to aid at keeping up the warmth 
of the surface of the body. Sudden changes in the 
atmosphere should be provided for, and additional 
clothing employed to protect from chilling. 

Remedies prescribed by the physician should be Function 
carefully given and their effect upon the functions 
of the body observed and noted. The bowels 
should be thoroughly evaucated once in twenty- 
four hours. If this is not a free movement, or if its 
passage is attended with difficulty, bringing about 
straining, the matter should be reported. The use 
of some saline water, as Hunyadi Janos, a half- 
tumblerful once or twice daily, and the proper use 
of massage over the abdomen in the daily treatment 
may bring about a permanent cure of this trouble. 
The color and consistency of the movements should 
be likewise observed. 

The quantity of urine passed in twenty-four Function 
hours should be noted. The usual amount in health 
is between forty and fifty fluid ounces. It may rise 
as high as eighty fluid ounces. The variation de- 
pends greatly upon the amount of fluid taken. 
The urine may be scanty when the patient has 
abstained from liquids, or when water has been 



190 



DISEASES OF WOMEN. 



eliminated in excess by skin or bowels. Thus free 
sweats or a persistent diarrhoea will greatly affect 
the quantity of urine passed in one day. Any 
diminution of the urine which approaches suppres- 
sion is of grave import and should be promptly 
reported. Temporary excess in the flow of urine 
will occur after hysterical paroxysms and other 
convulsive attacks. The color, quantity, reaction, 
and presence or absence of sediment should be noted. 
ofdigestuTn. Any disturbance of the digestion must be care- 
fully reported to the physician, as it is exceedingly 
important that digestion and assimilation should do 
their part to restore the broken-down system. 

Vaginal Injections. — The treatment of conditions 
of disease of the pelvic organs very frequently calls 
for the use of vaginal injections. 

Various methods have been suggested for giving 
these, and several different forms of vaginal syringe 
have been invented. The Davidson hand-ball 
syringe, or the Davidson fountain syringe, are 
those probably most frequently employed. The 
method as described by Emmett, who was the first 
gynaecologist in. this country to employ such 
douches extensively in his practice, is as follows : — 

" The injection can be better given to the patient 
after she is undressed for the night, and in bed. 
She should be placed near the edge of the bed 
with the hips elevated as much as possible by the 



Methods 
of giving 
vaginal 
injections. 



GENERAL NURSING IN PELVIC DISEASES. I9I 

bed-pan, and a small pillow under her back, the 
lower limbs being flexed. 

" Her body must be covered to protect her from 
cold and her position made perfectly comfortable ; 
whenever the bed is a soft one, for the purpose of 
keeping the hips elevated a broad board should be 

Fig. 47. 




Fountain Syringe. 



placed under the pan to prevent it from sinking 
into the bed from the weight of the patient. The 
vessel of hot water is placed on a chair by the bed- 
side, and the nurse passes the nozzle of the syringe 
into the vagina, over the perineum, directing it 
along the recto-vaginal wall (that is, the posterior 
wall of the vagina), until it reaches the posterior 



I92 DISEASES OF WOMEN. 

cul-de-sac (the portion of the vagina back of the 
neck of the womb). 

" The water must be thrown in at first very care- 
fully, until the vagina has become distended." 

In place of the interrupted stream used by work- 
ing the hand-ball syringe, as described in this 
method, the fountain syringe, the reservoir of which 
should be hung several feet above the patient's 
head, may be employed to even greater advantage, 
as it permits a continuous stream to flow into the 
vagina, and does away with the danger of the 
introduction of air or the forcible injection of 
water into the uterine cavity in cases where the 
uterine os has been torn. 

In private practice and in the absence of a nurse, 
the patient is often dependent upon herself for this 
treatment, hence she should be taught how to 
arrange for this. Dr. T. G. Thomas, of New York, 
suggests the following plan : " The patient places 
a pillow upon the edge of her bed, and an empty 
tub upon the floor under it. She then covers the 
pillow by a piece of india-rubber cloth which 
drapes into the tub. Then putting two chairs, one 
on each side and a little in front of the tub, she 
places a small table in front of these, and upon this 
another chair. Upon the chair which stands on 
the table a tub containing about two gallons of hot 
water is now put, near the bottom of which has 



GENERAL NURSING IN PELVIC DISEASES. 1 93 

been inserted a spigot to which a long rubber tube 
is affixed which ends in a vaginal nozzle. The 
patient now lies upon the bed, the pelvis elevated 
by the pillow, places her feet upon the chairs, cov- 
ers her limbs with a shawl or blanket, touches the 
spring — an ordinary clothes-pin makes a good one 
— which controls the flow, and the water bathes the 
vagina and running out is conducted by the india- 
rubber cloth into the tub. Here the only articles 
purchased are the tub with the spigot and tube 
attached, and a yard of india-rubber cloth, which 
are inexpensive." 

In our own practice in the hospital wards we Special 

apparatus. 

are accustomed to using, as a reservoir for the 
water, a large copper kettle which holds several 
gallons of water, called the douche-can. A spigot 
with rubber tubing is attached to the lower part of 
this. A rubber bed-pan with inflated border and 
outlet tubing, as shown in the cut, is employed, 
being placedon the edge of the bed upon a board, 
if the bed be yielding- It is well to protect the bed- 
ding beneath by means of a piece of rubber cloth. 
This may be long enough to drape down over the 
edge of the bed and be spread out upon the floor, 
the waste bucket being placed on it. The patient 
lies with the bed-pan adjusted under her, a pillow 
placed beneath her back to give it support. The 
douche-can filled with hot water, to which any 
13 



194 



DISEASES OF WOMEN. 



medicinal agent may be added, as directed by the 
physician, is placed upon a high stand, or on a 
stool or box placed on a table at the head of the 
patient's bed ; the spigot being turned and the va- 
ginal nozzle attached to the tubing properly ad- 
justed, the water flows into the vagina and thence 
into the rubber pan. Overflow is prevented by the 
water emptying into the waste bucket through the 



outlet tubing. 



Fig. 48. 




Rubber Bed-pan. 



A form of syringe, which -enables the patient to 
do without a bed-pan, has recently been devised. 
It is known as the Gordon Utero-Vaginal Irriga- 
tor. The nozzle is adjusted near a bulb, which is 
intended to fit into the vaginal orifice, and thus ob- 
struct the return flow from the vulva. An outlet 
of metal is connected with this bulb, and to it a 
long piece of rubber tubing is attached, which com- 



GENERAL NURSING IN PELVIC DISEASES. I95 

municates with a waste bucket. The patient lies, 
as before described, on the edge of the bed, with 
her limbs drawn up, a piece of rubber cloth beneath 
her hips. The reservoir containing the water to be 
used is placed at the head of the bed, elevated some 

Fig. 49. 




Utero- Vaginal Irrigator. 

distance above the level on which the patient lies. 
The tubing from the reservoir is connected with the 
receiving pipe of the bulb. Through this the water 
passes into the vagina, and is carried away by the 
outlet pipe and tubing. The bulb should be air- 
tight, for unless fully distended the water will 



196 



DISEASES OF WOMEN. 



Position 
in which 
vaginal 
injections 
are taken. 



escape through the vulva from around it and the 
value of the apparatus will be destroyed. The size 
of the bulb will of necessity have to correspond to 
the size of the vulva. This syringe, when it works 
well, is not only of advantage as doing away with 
the bed-pan, but will enable the douche to be taken 
at a much higher temperature than ordinary, for 
the water does not flow over the skin on its exit 
from the vulva, which is far more susceptible to the 
effect of heat than is mucous membrane. A tem- 
perature of from I20°-I25° Fahr. can thus read- 

Fig. 50. 




Vaginal Nozzle with Reverse Current. 

ily be borne. The nozzle of a vaginal syringe 
should have no opening at its extremity, but should 
be made so that a reverse rather than a direct cur- 
rent may be obtained. 

Where vaginal injections are intended for medi- 
cinal effect it is best that they should be taken 
lying down. In no other way can the water be 
carried so effectually to the diseased parts. When 
required only for cleanliness they may be adminis- 
tered in the upright posture, the patient being 



GENERAL NURSING IN PELVIC DISEASES. 1 97 

seated over a vessel. A convenient method is that 
of placing in a tub the water to be used — one or two 
gallons. The patient may seat herself over this on 
a board placed across it, or upon a stool placed in 
it, and inject the water by means of a hand-ball 
syringe. The long nozzle being used, the water 
may be thus made to bathe the cervix. When 
pessaries are worn, a daily cleansing injection is 
essential. 

The Tampon. — Many pelvic maladies are treated tampon. 
by the use of a tampon, or pledget of cotton or 
wool saturated or anointed with some medicinal 
agent. These may be placed by the physician 
daily, or two or three times weekly. It will be the 
nurse's duty to have these tampons in readiness. 
They may be made by cutting strips in the length 
of a lap of cotton or wool, from six to eight 
inches long, doubling these strips and tying a 
piece of twine about six inches in length to one 
extremity. • 

Before the tampons are placed the vagina should Preparatio 

, + . . . . . ...... iox use of 

be cleansed by an antiseptic injection, as bichloride tampon, 
of mercury 1-4000. As the medicinal applications 
used have frequently the effect of increasing the 
mucous discharge from the vagina, a napkin should 
be worn after these treatments. The cotton should 
be removed, at the time appointed by the physician, 
by drawing upon the string. It should be wrapped 



I98 DISEASES OF WOMEN. 

in a piece of paper and burned, or thrown down 
a privy vault — never, in a water-closet, as it will 
cause stoppage of the waste pipes. The patient 
should then receive a thorough vaginal injection. 

Pessaries. Pessaries. — Should the patient have a pessary 
adjusted, that is a support for the displaced uterus, 
the nurse should not permit her to move about if it 
causes her pain, at least until the physician acqui- 
esces in her doing so. Any unusual complaint of 
pain or increase of vaginal discharge from its pres- 
sure, should be reported to the physician. A pa- 
tient should understand fully that it is unsafe to 
wear such a support without the supervision of a 
physician, who shall advise her as to the necessity 
of having it removed from time to time for cleans- 
ing and replacement or entire removal. 

SitatTon. Counter-irritation over the lower part of the 
abdomen may occasionally be called for in the 
form of blisters, ointments, poultices, etc. In the 
rrfianagement of these the nurse should follow the 
ordinary rules for their application elsewhere. 
Poultices of flaxseed, or hot-packs, should, if re- 
quired for warmth, be applied frequently enough 
to keep up warmth, about once in two hours. The 
latter consist of pieces of flannel or several layers of 
soft muslin wrung out of boiling water, to which a 
little glycerine may or may not be added. These 
are applied as a poultice, being covered by a piece 



GENERAL NURSING IN PELVIC DISEASES. I99 

of oiled silk or muslin, and to still more effectually 
prevent evaporation, by a layer of cotton wool. 
An abdominal binder, held in place by a perineal 
bandage or an ordinary T-bandage, will serve to 
keep these applications in place. Ointments are 
best applied on patent lint or soft Canton flannel. 
They should be spread the thickness of a knife-blade. 
The best means of keeping such applications in 
place is by strips of rubber adhesive plaster. A 
piece of oiled silk or cotton batting should be 
applied over this to prevent the greasing of the 
clothing. 

A blister should be carefully watched and Blisters - 
removed as soon as the scarf-skin fills up with 
liquid beneath it. If it seems slow in rising, as it 
should in five or six hours, a flaxseed poultice 
applied over it will hasten the process. In dress- 
ing the blister, care should be taken not to remove 
the scarf-skin, but clipping a small opening in the 
most dependent part of the blister, the liquid may 
be soaked up by absorbent cotton or soft rags, and 
the blistered surface dressed with cold cream, cos- 
moline, etc., applied on lint. The fluid from the 
blister should not be allowed to run over the skin 
elsewhere, as it will produce irritation. 

Mental Occupation. — The more entirely a nervous ^S'ation 
patient's mind can be kept occupied with other 
things than herself, the more successfully may she 



200 DISEASES OF WOMEN. 

be treated. Upon the nurse will devolve the duty 
of supplying wholesome for unwholesome thoughts. 
For this reason, if none other, a nurse should keep 
up, as far as possible, a knowledge of the events of 
the day. She should be able to talk to her patient 
about the world and its doings, and thus help to 
widen the horizon and prevent the fret and worry 
which result from a persistent contemplation of 
small woes. All gossip should be carefully avoided. 
It is necessary that the nurse should be a good 
reader, and should train herself to read aloud, for 
she may in this way while away many a weary hour 
which might otherwise be spent in profitless 
thought. An additional recreation for younger 
patients particularly are some of the card games, 
or puzzles, etc., which are interesting because of 
the incentive they give to thought. 
Value With infinite tact a patient may be thus led, 

without knowing it, into a more wholesome mental 
atmosphere than that which she has been accus- 
tomed to breathe. The effect upon her general 
health when this state of things can be obtained 
will be marvelous. The nurse will need to remem- 
ber that each patient offers her a new problem, and 
that she must not attempt the same methods with 
all. 



CHAPTER XVI. 

PREPARATIONS FOR GYNECOLOGICAL 
EXAMINATIONS. 

The nurse is frequently called upon to aid the of disease, 
physician in obtaining a satisfactory history of a 
patient suspected of having pelvic trouble. The 
following plan is that generally adopted with us : — 

1. A short sketch of the family history, health of 
parents, brothers and sisters ; if any deaths among 
them, their cause. These facts are of importance 
as showing a predisposition to any especial class of 
diseases. 

2. The personal history of the patient, her health 
in childhood, the diseases from which she may then 
have suffered. Date of first menstruation, charac- 
ter as to existence of pain at periods ; amount 
of flow, regularity, etc. Date of marriage, number 
of pregnancies, number of miscarriages, number of 
labors, character of labors, character of convales- 
cence. General health during marriage or since 
puberty. 

3. History of the special disease from which the 

201 



202 DISEASES OF WOMEN. 

patient may be suffering ; its onset, duration, char- 
acter of symptoms, supposed cause, etc. 

4. Present state of health, general appearance, 
character of functions, appetite, digestion, quantity 
of urine passed in 24 hours; the urinalysis. Ex- 
amination of chest organs, abdominal organs and 
pelvic organs (determined by physician). 

5. Special examination with reference to tumor or 
existing disease. 

fmmi C din ex " Physical Examination. — The physical examina- 
tion of the pelvic organs is much better conducted 
upon a table covered with a blanket, rug, or com- 
fortable, and provided with a small pillow, than it 
can possibly be upon a bed or sofa. In this way 
one avoids the sinking of the body into the soft 
bed, and affords other facilities for a thorough in- 
vestigation of the diseased parts. A sheet or 
blanket for covering the patient gives the desired 
protection from exposure. 

When it is necessary to employ a bed a sewing- 
board, or the leaf of a dining-table slipped under the 
upper sheet and covering, gives a hard surface upon 
which the patient may lie. 

The patient's clothing should be loose around 
the waist, all the waistbands being unbuttoned or 
untied, corsets removed, and all heavy skirts. She 
should lie on her back in a first examination, unless 
directed otherwise by the physician. If the abdo- 



PREPARATIONS FOR EXAMINATIONS. 203 

men is to be examined first, the patient's feet may 
be placed on a chair or stand, as she lies on the 
table, the knees should be well drawn up so that 
the abdominal walls may be relaxed. A sheet 
should be spread over the lower limbs, the loosened 
skirts being either drawn down under it or thrown 
back over the chest, in order to expose the abdo- 
men. The sheet may be drawn up over the abdo- 
men, after the clothing has been adjusted for ex- 
amination, until the physician is ready to proceed 
to its inspection. The table should have been pre- 
viously adjusted in front of a window admitting a 
strong light. At the foot of the table should be 
placed a chair for the physician, and to its right a 
stand or chair with a basin of warm water contain- 
ing some antiseptic solution (bichloride of mercury 
1-4000), soap and a towel. 

When the pelvic examination is to be made the tf d pati5it nt 
limbs must be drawn up and separated, the feet 
resting on a level with the patient's buttocks. The 
patient's skirts are pushed up beneath the sheet 
until they rest over the abdomen; the sheet covers 
completely the lower limbs, pelvis, and abdomen. 

A variety of gynaecological tables and chairs s P ecial 
exist. The nurse will have to be taught the man- chairs - 
agement of any especial kind by the physician in 
whose office or hospital she may be called upon to 
work. In a private house an ordinary kitchen table 



204 



DISEASES OF WOMEN. 



serves the purpose very well. The chief advantage 
of the special tables consists in the foot-rests, which 
are so adjusted as to let the patient's hips be brought 



Fig. 51. 




Chadwick's Gynaecological Table with Patient Arranged for 
Examination. 



Use of 
anaesthetic. 



well to the edge of the table, thus facilitating the 
use of the speculum. 

Should the patient be extremely nervous, or the 
investigation involve much pain, it may be neces- 
sary for an anaesthetic to be given. This can only 



PREPARATIONS FOR EXAMINATIONS. 205 

be done with safety if the patient's stomach be 
empty. Therefore, it is well for the patient not to 
have taken any food for some hours before the ex- 
amination. The lower bowel should have been Preparation 

of bowels 

thoroughly emptied by an enema prior to the ex- and bladder. 
amination, and the patient should be required to 
void her urine. The condition of both these organs 
has much to do with success in an examination. 
It may be necessary, should there be difficulty in 
the voiding of urine, to use the catheter for the pa- 
tient prior to the examination. This should always 
be done immediately after etherization, when the 
patient requires to be anaesthetized, as the taking 
of ether, which usually causes considerable nervous 
excitement, is apt to lead to an excessive secretion. 
When an abdominal or pelvic tumor of any size 
exists, the soft rubber catheter, English or French, 
should be used. When the urethra is somewhat 
tortuous, the English catheter is preferable, because 
of its greater resistance. The silver or glass cath- 
eter might do injury to the tissues, because of its 
inability to adapt itself to the changes in direction 
of the canal. 

The instruments to be used by the physician in instruments 

J L ^ for gynseco- 

the course of the examination must be prepared logical ex- 

1 r animations. 

and handed to him by the nurse. 

These will be different forms of specula, as the 
bi-valve, the cylindrical and single-blade speculum, 



206 DISEASES OF WOMEN. 

the uterine dressing forceps, applicators, and pos- 
sibly, the uterine sound. 

There are many varieties of specula named for 

Fig. 52. 




The Uterine Sound. 



their respective inventors. Those most used are 
probably Cusco's bi-valve speculum, so called 



Fig. 53. 




Bi-valve Speculum. 

because of its having two blades. Fergusson's 
cylindrical speculum, made of clear glass, or glass 



PREPARATIONS FOR EXAMINATIONS. 207 

silvered and covered with black varnish, so that it 
will act as a reflector. 

Fig. 54- 




Virginal Bi-valve Speculum. 

The cylindrical speculum may also be made of 
celluloid or hard rubber. 

Fig. 55- 




Fergusson's Speculum, Cylindrical. 



The single-blade speculum, sometimes called the 
duck-bill speculum, or Sim's speculum, has also 
many modifications. 



208 



DISEASES OF WOMEN. 



Materials 
of which 
made. 



It is not necessary to remember these by the 
names of their inventors, but rather to know them 
by their special characteristics. 

Metallic specula are nickle-plated as a rule. 
Recently aluminium, which is a very light metal, 
has been used in making them. Aluminium specula 
have, further, the advantage of not tarnishing or 
corroding when they come in contact with the 



Fig. 56. 




wSim's Speculum (Duck-bill). 



Methods of 
cleaning. 



chemical substances ordinarily used in making 
uterine applications. Bichloride of mercury will, 
however, corrode it, hence solutions of bichloride 
will need to be avoided in using this, as other 
metallic instruments. 

Nickel-plated instruments should not be rubbed 
too vigorously or too frequently with sand-soap, 
whiting, etc., as the nickel wears off. The boiling 



PREPARATIONS FOR EXAMINATIONS. 



209 



or steaming of such instruments is the better way 
of cleansing them after use. 

The dressing forceps and sounds are usually of P ressin & 

01 J forceps. 

metal (steel, nickel-plated), although the flexible 
sound may consist of rubber. Applicators, that is^ s plica " 
small rods for the carrying of cotton charged with 
some medicament to the neck or body of the 
uterus, may be of metal, rubber, or wood. A very 
convenient and inexpensive applicator for hospital 
use is the wooden splint, about six inches long, 

Fig. 57. 




Dressing Forceps. 



which represents one stage in the process of the 
preparation of matches. These may be obtained in 
large quantities at match factories and kept with a 
little cotton twisted on one end for use as desired. 

The instruments as required for use by the Preparation 

1 'of instru- 

examining physician should be taken from a warm ments - 
carbolized solution in which they have previously 
been placed ; lubricated, if specula, with a little car- 
bolized cosmoline, in order that they may slip with- 
out resistance into the vagina, rectum or urethra, 
14 



2IO 



DISEASES OF WOMEN. 



Assistance 
during ex- 
amination 
and 
treatment, 



and handed thus to the physician. After the 
speculum has been placed the nurse will need to 
hand the dressing forceps, between the extremities 
of which a little dry absorbent cotton may be held. 
This will be needed to cleanse the passage of any 
discharge which may obscure the view. 

Similar pieces of cotton should be kept in readi- 
ness by the nurse, being placed as small twists or 
balls in a glass or china vessel within reach of the 
examiner, should more than the one be required. 

A waste bucket or bowl should be placed beneath 
the foot of the table to receive waste matter. 

Should the physician desire to make an applica- 
tion to the parts brought to view, the nurse may 
moisten the cotton on an applicator in a small 
quantity of the medicament specified by him, which 
should be poured out into a small china or glass 
vessel kept for the purpose. The cotton should 
not be saturated with the substance, as it may then 
drip over the tissues where not desired and produce 
unpleasant effects. 

Should a tampon need to be placed, this should 
similarly be prepared by the nurse, caught between 
the blades of the dressing-forceps and handed to 
the physician. 

Upon the removal of the speculum, and after 
having assisted the patient to alight from the table 
and dress, the nurse should give her attention to a 






PREPARATIONS FOR EXAMINATIONS. 211 

thorough cleansing of the instruments used, par- 
ticularly if they are to be immediately employed 
for another case. 

They should be placed in warm water and c . le . ansin g 

J r ot mstru- 

scrubbed with nail-brush and soap. Should there ments - 
be a steam sterilizer in operation in the room, they 
may then be dropped into it, until needed for the 
next patient. Ten minutes will suffice for their 
sterilization when the steam is at its height. In 
lieu of this boiling water may be poured over 
them, or they may be placed in a 5 per cent, car- 
bolic solution until again needed. On taking in- 
struments from so strong a carbolic solution, they 
should be rinsed in clear warm water before they 
are lubricated and handed to the physician for use, 
as they will otherwise cause the patient pain from 
the cauterant effect of the carbolic acid. Some phy- 
sicians sterilize their instruments for office use by 
holding them in the flame of an alcohol lamp for a 
few minutes. Another duty of the nurse in attend- menTof" 

■. . . , . . «ii 1 positions. 

ance upon a physician making examinations will be 
to place the patient in the positions desired. These 
positions are known as follows : — 

The lithotomy position, being the ordinary recum- 
bent position, the limbs being markedly flexed upon 
the abdomen. This is more commonly called for 
in certain operative procedures than during ex- 



212 



DISEASES OF WOMEN. 



Sims's 
position. 



amination. The method of maintaining it by the 
leg-straps will be described later. 

The Sims position, for bringing the uterine cervix 
within easy access, and for making rectal exami- 
nations. The patient lies on her left side, with her 
left arm drawn behind her, so as to let her rest on 
the left side of her chest. The right leg should be 



Fig. 58. 




Sims's Position. 



so flexed as to let the right knee lie just above the 
left. This position is necessary for the use of Sims's 
speculum. The patient's clothing being well drawn 
up under her hips and a sheet thrown over the 
lower extremities for their protection, the physician 
introduces Sims's speculum, which the nurse holds 
in place with one hand, while with the other she 



PREPARATIONS FOR EXAMINATIONS. 



213 



lifts the right buttock to aid in the exposure of the 
vulvar orifice and vagina. 

The knee-chest position is one which is frequently Genupec- 

1 l J toral, or 

assumed for the replacement of the pelvic organs knee-chest 

L l o position. 

or the appreciation of their mobility. 

This is obtained by having the patient place her- 
self upon her knees, and bend forward so that her 

Fig. 59. 




Germ-pectoral Position. 



chest may rest on a pillow placed upon the bed 
or table, her head resting beyond the pillow on one 
side or the other. The arms should be placed in 
an extended position at her side or may be clasped 
around the sides of the table, so that she may not 
be tempted to rest upon her elbows. This brings 
the hips at a level considerably above the head, and . 



214 DISEASES OF WOMEN. 

enables the abdominal and pelvic organs to gravi- 
tate toward the diaphragm. The patient's clothing 
should be pushed back from under her knees and 
lifted above her hips, the sheet being draped over 
her for the protection of the parts thus uncovered. 
A separation of the buttocks by the hands will allow 
of the entrance of air into the vagina, which will 
serve to force the pelvic organs forward. 

In cases of displacement of the uterus the nurse 
may be called upon to assist the patient to take 
this position several times daily. 



CHAPTER XVII. 

PREPARATIONS FOR GYNAECOLOGICAL OPERATIONS. 

The divisions of this subject may be classified as 
follows : — 

i. Preparation of the room. 

2. Preparation of the sponges, instruments, etc. 
• 3. Preparation of the patient. 

4. Preparation of operator and assistants. 

5. Nurse's duty during operation and convales- 
cence. 

PREPARATION OF THE ROOM. 

Excepting for vaginal hysterectomy (removal of 
the uterus through the vagina), which is to be 
regarded as a major operation, it will not be neces- 
sary to remove carpets, furniture, etc., from a room 
which is clean and thoroughly well kept. It is 
well, however, in any operation, to have special 
provision made for the protection of the floor. Protection 

L . for floor. 

Prior to the operation the room should be thor- 
oughly swept and dusted, and well aired. Super- 
fluous furniture and hangings, because they inter- 
fere with ventilation, it is always desirable to 

215 



2l6 DISEASES OF WOMEN. 

The table, remove. All operations are better done on a table 
than on the bed. Therefore one should be pre- 
pared by the nurse. As in operations on the pelvic 
organs, the patient will have to lie with her hips 
close to the edge of the table, the knees being 
drawn up. One table, of the ordinary size of a 
kitchen table, will be sufficient, without the table 
placed transversely to this for the head, as in ab- 
dominal section. 

Position of The table should be placed before a window, so 

table and . 

arran-e- that there may be thoroughly good light. Some 

ments for J ** J & & 

operation, protective, as a piece of oil-cloth or drugget, should 
be spread upon it. The arrangement of the dress- 
ings for the table should be the same as described 
for abdominal section — a blanket or comfortable 
spread over the table and tacked down round the 
edges. A piece of rubber should protect this 
covering, at least over the lower half of the table, 
when the operating pad is not used. A sheet 
should be spread over these and similarly fastened 
down at the sides. A blanket and sheet for cover- 
ing the patient, and a pillow protected with rubber 
cloth fastened around it, under the slip, should be 
arranged on the table. A chair should be placed 
at the foot of the table for the operator. The 
stand for his instruments should be placed to his 
right, within easy reach. On this stand — beside the 
instrument trays — should als.o be found a tray or 



PREPARATIONS FOR OPERATIONS. 217 

vessel containing a sterilized solution for him to 
dip his instruments into while in use, or to use in 
cleansing his hands, from time to time, of blood. 

Two assistants usually stand one on each side of 
the table, to aid the operator by holding the 
patient's limbs in any desired position, also in aid- 
ing with instruments, ligatures, sponging, etc. The 
nurse with her table for cleansing the sponges 
should stand back of the assistant on the operator's 
left, handing him sponges and receiving them from 
him for recleansing. Her stand should contain 
one basin filled with cold sterilized water for wash- 
ing out the blood, and another basin with warm 
sterilized water for keeping them in until needed.* 

A chair or stool should be placed at the side of 
the table to aid the patient in stepping up. The 
window should be screened from the outside gaze 
by a thin lace or muslin curtain, or a sheet of 
newspaper may be pinned across it. A waste 
bucket should stand under the table immediately 
in front of the operator. The operating pad may 
be placed at the lower edge of the table so that its 
flap rests over the waste bucket and thus conducts 
the water used in irrigation, etc., into it. 

When the operator works without a pad it is 
well to have a folded sheet so placed over the 

* When the operator attends to the sponging it is usually more 
convenient to have the sponges on the right. 



218 



DISEASES OF WOMEN. 



lower portion of the table as to extend from beneath 
the patient's hips over the lap of the operator. 
This serves to protect the operator's clothing, the 
floor at the foot of the table, etc., from soiling. 



Fig. 60. 




Operating Pad. 



The bed. 



The bed for the reception of the patient after 
operation should be arranged beforehand. It 
should be so placed that access may be had to it 



PREPARATIONS FOR OPERATIONS. 219 

on three sides. It should not face the light. A 
firm mattress, as of hair, is the most desirable. 
Care should be taken to see that the bed is in every 
way comfortable. A pad should protect the mat- 
tress, and a rubber protective should be so placed 
over this as to cover the portion of the bed, over 
which the parts operated upon shall rest. In pelvic 
operations this will be the middle of the bed, in a 
breast operation the upper part of the bed. A 
sheet is spread over these, and a draw-sheet, that is, 
a sheet folded upon itself twice in its length, is 
fastened over the portion of the bed beneath which 
the protective has been placed. 

A heated soapstone or hot-water bag: should be w armin g 

1 ° the bed. 

placed, previous to the operation, between the 
upper and lower bedclothes, so that the bed may 
be warm for the reception of the patient. 

The nurse should learn before the operation the Antiseptic 

L m solutions. 

kind of solutions to be used, if antiseptic solutions 
are to be employed. Should bichloride of mer- 
cury and carbolic acid be employed, which are the 
usual solutions desired by surgeons, a large bottle 
containing a solution of 1-500 or 1-1000 of the 
former and another containing 1-20 of the latter 
will enable the weaker solutions to be prepared 
with great rapidity. Thus, if a solution of 1-4000 
of the bichloride be called for, the nurse taking 
one part of the 1-1000 (as one gill) can add three 



220 DISEASES OF WOMEN. 

parts (or three gills) of warm sterilized water to 

this, thus obtaining a warm solution of the required 

Regulating proportion. If a bath thermometer be kept in the 

the tempe- x ^ x 

ratureof basin during" the admixture of the solution and the 

solutions. ° 

water, the nurse may, by watching the column of 
mercury, determine whether to make the addition 
from the warm or cold water, until she obtains the 
quantity desired. 
forqufck A solution of i-iooo can be prepared by mixing 

onS^ns. in equal parts the solution 1-500 and warm steril- 
ized water. 

A solution of 1-40 carbolic acid (that usually- 
employed for the immersion of instruments) may 
be made by adding the same quantity of warm 
sterilized water to a solution of 1-20. 

Sometimes surgeons prefer the use of tablets of 
bichloride in making up solutions. The directions 
as to the strength of one of these will be found 
upon the vial in each case. As a rule, a tablet 
represents 7^ grs., which, when added to a pint of 
water, gives a solution of 1-1000. A fountain 
syringe containing the solution to be used should 
be filled and hung behind and considerably above 
the operator, on a nail, that it may be ready when 
needed. 
Arrange- When the operator is obliged to use the edge of 

ments when r <=> & 

donjon 11 a k ec l i n place of a table, the bed should be placed 
bed - with one side sufficiently near the window to obtain 



PREPARATIONS FOR OPERATIONS. 221 

a good light. The sinking of the patient in the 
bed may be prevented by placing a board beneath 
the mattress and the springs, or between the mat- 
tress and pad. This portion of the bed should then 
be arranged for the operation in the same way that 
the table was arranged, as to the protective rubber 
and sheet. 

A chair or stool of proper height with reference 
to the bed should be placed in front of this arrange- 
ment. The floor, for about one foot beneath the 
bed, on that side, and extending to at least two 
feet beyond it, should be protected by floor oil- 
cloth or old carpeting. 

The stands and other articles required should be Prepara- 
tion of 
arranged as before described. The preparation of sponges, 

sponges and instruments for the operation will be 

identical with those described in the chapter on the 

subject of their preparation for abdominal section. 

The dressings employed will vary somewhat as to 

their character, form, etc., with the choice of the 

operator. 

For operations upon the floor of the pelvis, or T-banda g e 

L L A and anti- 

within the vagina, a T-bandage with an antiseptic septic pad. 
pad of some kind will be necessary. The T-band- 
age will consist of a straight abdominal bandage 
of firm muslin, to which a strip of muslin about 
four inches wide is fastened at right angles, so that 
it may serve as a perineal band passing between 



222 DISEASES OF WOMEN. 

the limbs and fastened before and behind to the 
lower edge of the abdominal bandage. 

A folded towel or napkin, pinned by a safety-pin 
to the abdominal bandage, serves the purpose very 
well. 

The antiseptic pad is usually made of one of the 
different kinds of antiseptic gauze, in which anti- 
septic jute, oakum, or cotton may be enclosed. 
occlusion In ^e Woman's Hospital the Garrigues "Oc- 

dressing. r o 

elusion Dressing," somewhat modified, similar to 
that used for obstetric work in the Maternity con- 
nected with the Hospital, has been employed. 

This consists of one or more pieces of dry patent 
lint, 6x8 inches, which have previously been ren- 
dered antiseptic by saturation in a solution of bichlo- 
ride of mercury i-iooo. 

These are placed over the vulva, doubled in their 
width so as to make a dressing 3x8 inches. The 
lint is then covered by a piece of gutta-percha 
tissue, 4x9 inches, which is wet in a 1-4000 solu- 
tion of bichloride of mercury. 

These dressings are kept in place by a napkin of 
sublimated cheese-cloth, 18 inches square, folded to 
form a diagonal 5 inches in width, within whose 
folds a pad of oakum is enclosed. The napkin is 
tightly fastened to an abdominal bandage, both 
anteriorly and posteriorly, by means of safety pins, 
and the access of air to the vagina is thus prevented. 



PREPARATIONS FOR OPERATIONS. 223 

These dressings are changed as they may require, 
according to the amount of discharge. Should the 
catheter have to be used at stated intervals, fresh 
dressings should be employed in again protecting 
the parts. 

The nurse can obtain the cheese-cloth at any 
dry-goods store, and prepare it by first thoroughly 
washing with soft soap and boiling, and then wring- 
ing it out in a solution of bichloride of mercury 
i-iooo. The patent lint, obtained in a drug store, 
may be rendered antiseptic in the same way. The 
gutta-percha tissue and oakum may also be obtained 
at a drug store, the former more advantageously, 
perhaps, at a rubber store, where also a good 
syringe should be obtained for use in the case, if 
required. 

Although bichloride gauze is most commonly 
used, iodoform gauze may be preferred by some 
surgeons. 

The preparation of ligatures and sutures, the 
threading of needles, etc., does not usually devolve 
upon the nurse, yet may be required of her. The 
same rules must be observed as in their preparation 
for abdominal operations. The needles vary much 
in size and shape, according to the character of the 
operation to be done. The surgeon, too, will have 
his own choice as to the kind of needle he prefers. 



224 DISEASES OF WOMEN. 

The nurse must, therefore, learn his preference and 
observe it. 

A sterilized towel, containing a set of dressings 
neatly folded, the bandage, safety-pins, and box of 
iodoform or other powder to be used in the dress- 
ing of the wound, should be brought to the surgeon 
by the nurse at the proper time for their applica- 
tion, hence should be kept in readiness. 



CHAPTER XVIII. 

PREPARATION OF THE PATIENT, OPERATOR, AND 

ASSISTANTS. 

First of all it is important to get the patient into me ^°ta?con- 
a good mental condition. She should have her 
thoughts, so far as possible, kept off the operation. 
The utmost tact will be necessary to manage this 
successfully. 

It is well to make all the preparations for opera- 
tion elsewhere than in the presence of the patient. 

If the operation is to be on the pelvic organs, in- Prepara- 

r r & ' tion of 

volving vagina, uterus, bladder, or rectum, it will be bowels - 
especially necessary to have a thorough evacuation 
of the bowels. The night before the operation a 
laxative or purgative may be given, and the morn- 
ing following ; the lower bowel may be further 
cleansed by an injection of soap and water. 

The patient should not have any breakfast on the Abstinence 

r , . xr i • from food. 

morning ot the operation. It the operation is not 
to be done before noon, she may receive a cup of 
coffee or tea or a cup of beef-tea early in the morn- 
ing. 

She should remain in bed, lest she should feel Rest 
faint for want of food. 

I S 225 



226 



DISEASES OF WOMEN. 



Bath. 



Clothing. 



Arrange- 
ment of 
hair. 



Vaginal in- 
jection. 



Cleansing 
and disin- 
fection of 
vulva. 



Shaving of 
parts. 



Adminis- 
tration of 
the anaes- 
thetic. 



A full bath should have been taken on the night 
previous to operation. She should wear, according 
to the weather, a merino or gauze vest, a pair of 
drawers and stockings, a long night-dress. When 
the vest is worn a chemise should be dispensed 
with, as it is an awkward garment to remove when 
a change is needed, especially where the patient 
must be kept as quiet as possible. The hair should 
be parted in the back and plaited in two braids, one 
behind each ear. This is most convenient when 
lying upon the back, and prevents matting of hair. 

A vaginal injection of bichloride of mercury or 
some other disinfectant will probably need to be 
given just before the operation. The vulva and 
surrounding parts will need especial preparation by 
a . thorough cleansing, first with soap, preferably 
green soap, and warm water, and then with some 
disinfectant solutions. The hair about the vulva 
is often shaved up to a level with the " meatus uri- 
narius," or entrance to the bladder. The choice of 
the surgeon regarding the shaving should be learned 
by the nurse previous to her attempting the same. 
Many surgeons prefer attending to the especial pre- 
paration of the site of operation after etherization. 

In private houses the anaesthetic is generally 
administered in an adjoining room, and the patient 
afterward carried in and placed upon the operating 
table. The nurse aids the surgeon in carrying 



PREPARATION OF PATIENT, ETC. 



227 



She Should learn from Arrange- 
ment of 



out these arrangements. 

him in what position the patient is desired when patient, 
placed upon the table. The dorsal position — the 
patient lying upon her back with the limbs flexed — 
is that usually required for operations upon the 
vagina or the perineum. The patient's clothing in 



Fig. 61. 





Leg-holder. 



this position should be well drawn up from under 
the hips and pushed above the operating-pad, 
which is then placed under her. The limbs, being 
flexed, may be fixed in position by the leg-holder, as Leg hoIder - 
shown in the cut, or held by assistants. The leg- 



228 DISEASES OF WOMEN. 

holder, being thrown around the patient's neck, is 
fastened, just above the knee, to each limb. 

A sheet should be so draped over the person as to 
cover the limbs and protect the patient so far as pos- 
sible from unnecessary exposure. Some operators 
use loose bags of muslin, which have been previ- 




J 




Dorsal Position and Arrangement for Operations on Floor of Pelvis. 

ously sterilized, for encasing the limbs during 
operations. 

A double fold of sterilized gauze, about a yard 
square, with a slit cut in it, through which the 
special site of operation may be exposed, is used 
by some surgeons as a further protection against 
exposure, being draped from beneath the sheet over 



PREPARATION OF PATIENT, ETC. 229 

the vulva and buttocks, the operator carrying on 
his manipulations through the opening which 
exposes the special site to be operated upon. 

The Sims position is frequently used in cervical sim . s > 

1 l J position. 

operations, for fistulae, or for operations about the 
anus, as for hemorrhoids. 

The knee-chest position is but seldom used for toS^p^sT- 
operation except in certain forms of fistulae. The tI0r1, 
patient's chest in such cases may need to be sup- 
ported by a thick pillow or a padded stool, to bring 
her into proper position for the operator. 

The nurse should in every case aim to keep the 
patient's clothing out of the way of the operator 
and from contact with the discharges, but she 
should so adjust sheets, towels, etc., as to save the 
patient any unnecessary exposure. 

The preparation of the operator and assistants t ^ pa f ra_ 
will be practically the same as that observed in anTassist- 
preparation for abdominal section. ants " 

Any open surface upon the patient's body may 
become a source of infection, therefore the require- 
ments of asepsis and antisepsis should be as rigidly 
observed as possible in the preparations for any 
operative procedure. 



CHAPTER XIX. 

DUTIES OF NURSE DURING OPERATION. 

The patient being placed, and the operation 

to"p"nges. begun, the nurse, unless directed otherwise, will 

need to station herself by the stand which contains 

the vessels for cleansing the sponges. Several 

"Mounted « mounted sponges" should be prepared, that is, 

sponges. -l o r r 

sponges cut about the size of a walnut, placed on 
stems of metal or rubber, called sponge-holders. 
Forceps with catches may be used when these are 
not on hand. 

For operations in the vagina or on the cervix, 
etc., these mounted sponges are especially neces- 
sary. 

Attention 

to surgeon's I he nurse, while attending to the sponges, espe- 
cially, should be ready to respond to any demand 
changing f the surgeon — changing- the water in the basins, 

of solutions & & & 

in basins, refilling; the irrigator, removing soiled towels and 
Cleansing replacing them with fresh. Her own hands should 

of her own ^ o 

hands. j^ ca refully cleansed after each of these services, in 
a basin containing some antiseptic solution, as 
1-4000 bichloride of mercury, before she again 
touches the sponges. 

The sponges should be thoroughly cleansed of 
230 



DUTIES OF NURSE DURING OPERATION. 23 1 

blood in the basin of cold water and allowed to lie Manage- 

t»i 1 ment of 

in warm water until wanted. They should be sponges. 
squeezed until as free of moisture as possible, and 
should be handed in quick succession to the assist- 
ant nearest to her who will have the sponging to 
attend to. 

At no time in any operation should the nurse ofSI^shy. 
allow herself to become so engrossed in watching 
the operation as to forget that there are duties 
incumbent upon her. She should give her sole to duty? n 
attention to the performance of her own duties, and 
no more think of watching the operation (except 
as she may need to do so for the proper apprecia- 
tion of the special duties that may devolve upon 
her at each step), than should the etherizer, whose 
sole attention should be engrossed in the proper 
performance of his work. 

At the completion of the operation, the nurse ;^ p e le .. at 
may assist in slipping the rubber pad from beneath operation. 
the patient. It may be placed in the waste bucket 
temporarily, while she proceeds with a sponge and 
a dry sterilized towel to prepare the parts for the 

... r 1 1 • ttt, «ii Application 

application 01 the dressings. When entirely dry of dressings. 

the powder, boric acid, or iodoform may be applied 

by the surgeon, and then the dressings are put in 

place and fastened down by a bandage. A blanket 

is then wrapped around the patient and she may be Removal of 

lifted into the bed which the nurse, just before theg^ ientt0 



232 DISEASES OF WOMEN. 

application of the dressings, should have prepared 

for her reception, by turning down the covers and 

removing temporarily the hot soapstone or water- 

Appiication bag. The latter may then be replaced at the pa- 

of warmth. ° J l r 

tient's feet ; a soft towel should have been placed, in 
lieu of a pillow, under the patient's head and another 
auemSns towel should be placed under her chin. A light 
basin for the patient to vomit in, in case she is sick, 
should be placed under the head of the bed; a 
chair for the doctor should be placed beside the 
bed. While the doctor and his assistant give their 

Removal of 1 • 1 • i 1 

aniHes attention to the patient, the nurse may quickly 

used during 

operations, remove all the articles used during the operation. 



CHAPTER XX. 

SPECIAL NURSING IN GYNAECOLOGICAL 
OPERATIONS. 

There will be little points of -difference in theoretic 

in manage- 



Points of 



management of each case, which will depend upon ^2? 
the character of the operation performed. Some cases ' 
of the most frequent gynaecological operations will 
therefore be referred to separately, in order that 
the especial points in their nursing may be demon- 
strated. 

After minor operations there is seldom the pro- immediate 

1 • *■ attentions 

found shock which exists after an abdominal or after \ . 

operation. 

any other major operation. Should there be, the 
nurse will need to give her attention to the restora- 
tion of the patient, as has already been described 
in the treatment after abdominal section. 

Should the nurse not be needed by the patient, room. smg ° 
the doctor or his assistants remaining for a short 
time with her, the nurse may quietly and quickly 
busy herself with removing the operating table, 
soiled sheets, towels, etc., and setting the room in 
order. When the doctor leaves, her place is by 
her patient. 

Careful directions should be received by her as Sections. 
233 



234 



DISEASES OF WOMEN. 



Perineor- 
rhaphy for 
rupture of 
perineum. 



Complete 
rupture. 



Prepara- 
tory treat- 
ment for 
operation. 



The 
bowels. 



to her especial duties in each case. She should 
inquire of her surgeon whether the patient may be 
permitted to have her position changed from time 
to time; what shall be done concerning the use of 
the catheter; the amount of nourishment given the 
patient ; the use of any medicines, etc. These facts 
should be carefully put down on paper and kept 
for her guidance in the care of the case. 

Rupture of the perineum is so frequent that the 
operation for its repair, known as the " perineal 
operation/' is the most common of the gynaeco- 
logical operations. The extent of the laceration 
which is usually the result of childbirth varies. 
When it extends through the sphincter muscle of 
the bowel it is called a complete rupture. 

It is not only important in the repair of these 
injuries that the operation should be well done, but 
that the healing of the wound should in every way 
be promoted. The patient's general health should, 
therefore, be in a satisfactory condition, and the 
bowels should have received very careful attention 
for several days. When we remember that, the 
intestinal canal is about twenty-five feet long, and 
that fecal masses are often kept stored up in it for 
months, we can understand how free evacuations 
on several successive days maybe necessary before 
the patient is in fit condition for operation. Some 
laxative, as recommended by the physician in 



SPECIAL GYNECOLOGICAL NURSING. 235 

charge of the case, will be necessary during this 
period. The opening of the bowels twice every 
twenty four hours is not too frequent. An enema 
will need to be administered a few hours before 
operation. Care should be taken not to set up a 
diarrhoea, as this condition may cause greater 
inconvenience than constipation during the con- 
valescence. The preparatory treatment will also 
include attention to hemorrhoids, if they exist, or^™ 01 - 

J rhoids. 

discharges from the uterus and vagina. When 
hemorrhoids exist, it is well to keep them sup- 
ported by a T-bandage, and a compress over the 
anus. 

Discharges from the vagina, which may interfere Y a g[ nal 

& e> > J discharges. 

with healing, must be cured before the operation is 
undertaken. The use of hot-water injections, given 
by the nurse, and local treatment as required by the 
physician, will be necessary for this. 

For the operation the patient will need to be during 11 
placed in the lithotomy or dorsal position. The ° per< 
preparations for fixing her in this position should, 
of course, not be undertaken until she is fully 
etherized and no longer in a condition to be fright- 
ened by them. 

Her limbs may then be flexed upon the abdomen Special ar- 

J ± rangements 

and held either by an assistant on each side, or by [° r n opera ~ 
the legholder. The clothing under her back being 
well pushed up, the hips are brought to the edge 



236 DISEASES OF WOMEN. 

of the table and the operating pad adjusted beneath 
them. The parts are washed thoroughly, first 
with soap and water and then an antiseptic solu- 
tion, and the hair on the posterior part of the 
vulva and the perineum shaved away or cut close. 
Sterilized sheets or towels are made to envelop the 
limbs and protect the parts. A large pan or foot- 
tub should lie just below the parts on the floor, so 
as to catch blood or water used in irrigation. The 
labia are held apart by the assistants on each side. 
The fingers of one hand of each of the assistants 
can hold back these greater lips, while the other 
hand of each remains free to assist with sponges, 
holding instruments, etc. The assistants should 
stand so as to keep out of the operator's light. 
The nurse attends to cleansing and handing the 
sponges, changing the water in the basins, and 
responding to the needs of surgeon and assistants. 
Application After the completion of the operation a T-bandage 

or dressings. * l ° 

with antiseptic dressings, as before described, may 
be applied or not, according to the wish of the 
After-care, surgeon, and the patient placed in bed. The knees 
and thighs are flexed, and she is put to bed on the 
right or left side, as a rule, although many surgeons 
now put little stress upon position as important in 
the after-management of their cases. Some sur- 
geons prefer that the patient should continue to 
lie on her side, her position being made comfort- 



SPECIAL GYNAECOLOGICAL NURSING. 237 

able by pillows, until a day or two after removal of 
sutures. 

The external parts will, from time to time, require 
washing, as a rule, as there is sometimes a little dis- 
charge. The washing may be accomplished by 
means of a stream of tepid antiseptic solution, as 
bichloride of mercury 1-4000, or 1-40 of carbolic 
acid, from a syringe, and the parts then carefully 
dried with a piece of antiseptic lint or gauze. If 
there is no discharge, the parts should simply be 
kept dry. A powder, as boric acid or iodoform, 
may be dusted over the site of the wound from time 
to time to insure this. The vagina will only need 
to be washed out, should there be a discharge. 
Great care must be taken in the insertion of the 
nozzle that no injury is done to the stitches. It 
should be seen that the water returns freely from 
the vagina. Pressing the nozzle of the syringe 
against the anterior wall of the vagina will be apt 
to leave space enough for the return current. 

The catheter may need to be used every six or catheteri- 
eight hours for several days. A loaded bladder za 
makes the patient restless. Some surgeons prefer 
having the patient pass her water from the first. 
There is probably little, if any, danger of urine irri- 
tating the wound. Should the urine be passed, the 
parts should be afterward irrigated with an anti- 
septic solution and thoroughly and carefully dried. 



238 DISEASES OF WOMEN. 

The use of the catheter, unless aseptically carried 
out, may cause irritation of the bladder, which is 
often a source of great suffering. 
Time and The question of opening the bowels is very im- 

method for - 1 10 j 

securing^an portant, especially in cases of complete rupture. 

the bowels. The practice of surgeons differs in this respect. 
Some keep the bowels locked for a week or ten 
days by the administration of opiates. The usual 
practice, however, is to keep the bowels free from 
the first, as the hard masses (scybala) which are apt 
to form put the united parts to great danger, from 
the strain to which they subject them. 

If the bowels have not been moved by the fourth 
day, the practice is to administer a gill of cotton- 
seed oil by bowel, allowing it to remain while laxa- 
tives are administered by mouth, as a teaspoonful 
of castor-oil every hour, until four to six doses 
have been taken, or the bowels feel like moving. 
The dose of oil may be administered in a half a 
Seidlitz powder, flavored with a drop of oil of 
peppermint, or gaultheria, or a little syrup of gin- 
ger, etc. This prevents the nausea attendant usually 
upon taking the oil. By this method, a soft evacua- 
tion of the bowels is secured, and, if the precaution 
be taken to have the patient lie on her side while 
the bowels are moved, there will be little injurious 

ciean e s ?n- nt effect from strain. A thorough irrigation and cleans- 
ing and drying of the parts should follow. Should 



1 



SPECIAL GYNECOLOGICAL NURSING. 239 

the patient be disturbed by flatus before the bowels Relief from 
are moved, having a bearing down sensation with 
pain, an English catheter, about No. 9 or 10, may 
be insinuated into the bowel and thus aid the 
escape of gas. 

The diet of the patient for 24 to 48 hours should Diet - 
be simply milk, broth, or beef-tea, and this with 
farinaceous foods should be given until about the 
fifth or sixth day, when meat should be given. 

The deep perineal sutures, or stitches, should be 
removed in about eight or ten days. The rectal 
sutures do not always require removal. The nurse 
will need to place the patient across the bed for the 
purpose, drawing her hips close to its edge and 
flexing the limbs. Her limbs should be protected 
by slipping on a pair of drawers and stockings. A 
sheet should in addition be thrown over her and 
draped around the limbs. A sheet or napkin should 
be placed under her hips. 

A chair for the surgeon should be placed in front 
of the patient, and a sheet or towel thrown over his 
knees as he takes his seat. 

As the surgeon usually desires to give a vaginal 
injection before removing the stitches, if he has not 
directed the nurse to attend to giving this injection 
herself, she should have in readiness the antiseptic 
solution required, a syringe, and a bedpan. The 
instruments, straight, sharp-pointed scissors and a 



240 



DISEASES OF WOMEN. 



pair of anatomical forceps, should be placed in a 
tin basin and immersed in a carbolic solution 1-40. 
An antiseptic solution, as 1-4000 of bichloride of 
mercury, should be prepared in a china or agate 
basin for the doctor's hands. 

A pus-pan or piece of paper for receiving the 
stitches as removed should be placed on the bed, 
within convenient reach of the surgeon. The nurse 

Fig. 63. 




% 



<% 



Aseptic Anatomical Forceps. 
The two branches being separable are more readily cleansed. 



Removal of should then support the patient's limbs, or, if there 

sutures. 

are other assistants to do this, she will assist the 
surgeon in giving the douche, and in obtaining for 
him or handing him the various articles required as 
he needs them. After the removal of the stitches 
she assists in putting the patient properly back in 
bed and removes the articles which were used in 
the operation. 



ure of 
perineum. 



SPECIAL GYNAECOLOGICAL NURSING. 24 1 

The patient will need to be kept quiet, as a rule, Necessity 

. for quiet 

for a day or two after the removal of the stitches, after 

sutures 

The nurse should, however, always learn from the removed. 
surgeon his special wishes concerning the subse- 
quent management of a case. 

In partial rupture of the perineum the manage- fj^^S&i 
ment is practically the same as in complete rup- jjjjgj 
ture, except that there will be less fear of damage 
when the bowels are opened on the third or fourth 
day, and that the stitches are usually removed at 
the end of a week. 

The operation for repair of the perineum is known 
as perineorraphy. The various methods of doing 
this operation are known by the names of their 
different inventors. 

Elytrorrhaphy or colporrhaphy are commonly f^l tr ^ r ' or . 

known as " vaginal operations," that is, operations Jr h °J p £ r " 

on the vagina for the relief of prolapsus, or falling 

of the womb. 

The after-treatment is much the same as in cases After-treat- 
ment. 

where rupture of the perineum has been repaired. 

The patient will need to lie in bed for over two 

weeks, and the bladder must never be allowed to 

become distended, or the cicatrix will be stretched 

or broken down. The sutures are removed from ^^ lof 

the tenth to the fifteenth day. The patient will 

need to avoid active exercise for many months. 

Trachelorraphy is an operation done for the 
16 



242 



DISEASES OF WOMEN. 



Trachelor- 
rhaphy or 
cervical 
operation. 



Prepara- 
tory treat- 
ment. 



The opera 
tion. 



Rest in 
bed. 



The 
bowels. 



Diet. 



Vaginal 
injections. 



repair of the cervix or neck of the womb when 
laceration exists. It is frequently spoken of as a 
" cervical operation." Before this operation is per- 
formed, the surgeon generally has the patient put 
upon preparatory treatment for a week or two, to 
remove all tenderness and congestion. Hot water 
injections daily, sometimes several times a day, are 
ordered, after which the doctor may apply tam- 
pons of glycerine, etc. 

Some surgeons prefer the semi-prone or Sims's 
position for this operation, as this enables the neck 
of the womb to be brought within easy reach. The 
operation is more frequently performed with the 
patient on her back, in what is called the dorsal 
or lithotomy position. 

The patient should remain in bed a fortnight or 
more after the operation and remain in the recum- 
bent position so that there, may be no strain upon 
the stitches. Some counter-irritant, as burning 
fluid, is frequently applied on cotton over the lower 
part of the abdomen. The bowels should not be 
allowed to get constipated, a movement being se- 
cured by means of laxatives daily or every other 
day. 

The patient's diet need not be restricted. After 
the second day, especially if there be much dis- 
charge, a vaginal injection of tepid water, contain- 
ing some antiseptic (as bichloride of mercury 



SPECIAL GYNAECOLOGICAL NURSING. 243 

1-4000), may be employed. After urine has been 
passed or the catheter used, it is also well to use a 
warm-water injection to avoid irritation of the 
wound through urine which may pass into the 
vagina. 

The sutures are sometimes removed as earlv a s R ! movalof 

■* sutures. 

the seventh day. The patient is placed in Sims's 
position for this, and the nurse 'will have to hold 
the speculum and support the right buttock, the 
patient lying on her left side, and vice versa when 
she lies on her right side, while the surgeon 
removes the stitches. More frequently the sutures 
are not removed until the fourteenth day, or even 
later. The patient should be kept quiet for some After-care. 
days after the removal of the stitches, not even 
sitting up in bed. This is to give time for the 
cicatrix to grow stronger. The nurse will, of 
course, observe the wishes of the surgeon in this as 
in other matters pertaining to the nursing. 

Operations for fistulae are not infrequent. A fis- fo? fiTtuSe! 
tula is an unnatural opening produced by sloughing 
of the tissues. It may be the result of cancer, but 
in operable cases is more frequently the result of 
childbirth. The constant pressure of a pessary 
worn too long may cause it. An opening may in 
this way be formed between the bladder and the 
vagina, in which case it is called a vesico-vaginal \l(^* oi 
fistula, or it may be formed between the bowel 



244 



DISEASES OF WOMEN. 



Symptoms. 



Method of 
conducting 
examina- 
tion. 



Spontane- 
ous heal- 
ing. 



Precau- 
tions to be 
observed. 



Operation 
for vesico- 
vaginal 
fistula. 



Prepara- 
tions. 



and the vagina, when it is called a recto-vaginal 
fistula. 

Constant dribbling of the urine is occasioned by 
the former condition, while escape of faeces through 
the vagina is a result of the latter. 

The lithotomy position is that usually employed 
in doing the operation, or examining for the condi- 
tion. A Sims speculum retracts the perineum. 
When it is difficult to detect the fistula, warm milk 
may be injected into the bladder or rectum, and the 
vagina watched to discover where it makes its exit. 
This will betray the position of the fistula. 

Should a fistula occur as the result of a difficult 
delivery, it is possible that, if at once discovered 
and properly treated, it may heal without an opera- 
tion. The vagina should be kept perfectly clean 
by frequent syringing with warm antiseptic solu- 
tions, and a self-retaining catheter should be 
placed in the bladder and the latter thus kept 
empty. 

In performing the operation for vesico-vaginal 
fistula the surgeon will have the patient placed in 
the position he may prefer — the lithotomy, the 
semi-prone, or the genu-pectoral. The lithotomy 
position is usually employed. The bowels should 
be thoroughly cleared out by a laxative adminis- 
tered about forty-eight hours before the operation, 
and an enema an hour or two before the operation. 



SPECIAL GYN/ECOLOGICAL NURSING. 



245 



The patient's limb may be held by the leg-holder, 
the hips being placed over the operating pad. 
When all the stitches have been tied, the vagina 
and the bladder may be washed out with warm 
water (sterilized). If water is found to escape from 
the bladder into the vagina from the site of the 
wound, the operator will need to insert more 
stitches. After the operation* a self-retaining After " care> 
catheter must be placed in the bladder to keep the 
urine drawn off. Some operators do not employ 
this. The catheter usually employed is the short 

Fig. 64. 




S-shaped Catheter. 



1 catheter 



catheter with a bulbous extremity to prevent its 
slipping out of the bladder. The sigmoid or 
S-shaped catheter requires more frequent removal The . s ? lf - 

1 J- *■ retaining 

for cleansing, and is more apt to do injury upon its * 
withdrawal and introduction, which must be done 
daily for cleansing it. The upper curve of the S is 
intended to hold the catheter in place by resting 
against the pubic bone. The bulbous catheter 
may be made of hard rubber or vulcanite, and will 
need occasional removal for cleansing purposes. 



246 DISEASES OF WOMEN. 

It is best washed in a strong solution of acetic 
acid. 

Position in After the operation the patient is placed in bed, 
on her left side. When a catheter has been intro- 
duced as described, a coach-urinal or a bed-pan 
should be placed in the bed, behind the bent knees, 
which should be fastened together by means of a 

menTfor" bandage. A piece of flexible rubber tubing is 

drawing off ^^ Qn ^ ^ catheter at Qne en( ^ j-J^ OJ -J ler 

being passed into the urinal. When the patient is 
permitted to lie upon her back, the receptacle for 




Bulbous Catheter. 

the urine will need to be placed beneath her limbs. 
It is more liable to be pushed out of place in this 
position. The nurse must frequently empty and 
cleanse the receptacle, to keep the bed free from 
T he . odor.* The bowels must be kept in good condi- 

bowels. L ° 

tion, no hard masses being allowed to collect in them, 
so as to cause irritation. No straining effort should 

* Some operators prefer having a long piece of rubber tubing 
fastened to the self- retaining catheter — the other end hanging over 
the side of the bed, and emptying the contents of the bladder into a 
vessel at the side of the bed. 



SPECIAL GYN/ECOLOGICAL NURSING. 247 

be permitted. The fecal masses, if they exist, 
may be softened by the injection of a gill of warm 
cotton-seed oil; in three or four hours a pint and a 
half of soap and water may be injected. Should 
several hours elapse and the enema be retained, 
it is a good plan to introduce a tube (as the long 
vaginal nozzle) to the extent of about four inches, 
letting the outer end rest over a soap dish con- 
taining a little water. The tube, if left thus ten 
or twenty minutes, will usually carry off a quantity 
of flatus, and then the patient will, as a rule, have 
a free motion. Should the first enema prove 
unavailing, the process may be repeated. 

Before the stitches are removed, a free evacuation 
of the bowels should be obtained, and the vagina 
cleansed with an antiseptic solution. The sutures ^™°™ lof 
are removed about the eighth or tenth day. The 
patient is placed in the semi-prone position and 
Sims's speculum used. For this process, the patient 
is best placed on a table, as a good light is required. 
Some of the complications which may occur after 
this operation are as follows :■ — 

Hemorrhage into the bladder — perhaps the most Hemor- 

_ rhage into 

common accident — is shown by the color of the the bladder, 
urine drained off, and, if managed in the beginning 
by injections of warm water, can thus be usually 
checked. If irritation of the bladder, however, 
persists, and it is found that the bladder is dis- 



248 



DISEASES OF WOMEN. 



Secondary 
operation. 

Closure of 
ureter. 



Cystitis. 



Manage- 
ment. 



Operation 
for recto- 
vaginal 
fistula. 



tended, yet nothing can be drawn off by the cathe 
ter, the distention must be due to clots, and the 
surgeon may have to reopen the fistula and remove 
the clots. Sometimes severe pain occurs extending 
from the kidney on one side down to the blad- 
der. This symptom should be carefully reported, 
as it may imply that a ureter has been closed, and 
the removal of some stitches may be necessary. 

Cystitis, or inflammation of the bladder, is often 
a serious complication, as it leads to pain and a 
constant desire to empty the bladder, hence strain- 
ing efforts which may prevent the healing of the 
fistula. The bladder may need to be washed out 
frequently with warm water containing boric acid 
or chlorate of potash, and the self-retaining cathe- 
ter cannot be worn. The surgeon will attend to 
the process of washing out the bladder, and the 
nurse should not attempt it unless directed by him. 
Warm poultices over the lower part of the abdo- 
men, and flaxseed tea or other diluents may 
need to be administered. Thus a tumblerful of 
flaxseed tea may be administered once in three or 
four hours. 

In recto-vaginal fistula the operation is conducted 
on the same principle as when a vesico-vaginal fis- 
tula is treated. The bowels must be thoroughly 
cleaned out by an aperient administered twenty- 
four hours before operation, followed by an enema 



SPECIAL GYNAECOLOGICAL NURSING. 249 

an hour or two before the patient is placed upon 
the table. 

A rectal tube or large-sized English catheter will 
need to be retained in the bowel after operation to 
carry off flatus. The rules for after-treatment will 
be the same as in repair of complete rupture of the 
perineum. The chief trouble will consist in de- 
ciding as to the time when the bowels may be 
moved with safety. Efforts should be made to 
secure a soft movement by means of the oil enema, 
as already described. 

t . Removal of 

lhe removal of urethral caruncle is another op- urethral 
eration very frequently performed. The caruncle 
is a small, sensitive tumor, sometimes of quite a 
bright red color, which is found at the entrance to 
the urethra. It causes pain and difficulty on uri- 
nation, hence should be removed. When such 
growths cause no unpleasant symptoms, as is 
occasionally the case, it is not necessary to disturb 
them. 

The patient for this operation should be placed ^ opera " 
in the lithotomy position, and the urine drawn off 
after she has been etherized. 

The Paquelin thermo-cautery is frequently used ]^f° t a ff ' 
to sear the bleeding surface left by the removal of ^ t "ry ns 
the tumor. The nurse may be called upon to pre- 
pare the cautery and have it in readiness. The 
finest point being fitted to the handle, it should be 



250 



DISEASES OF WOMEN. 



allowed to rest over the flame of an alcohol lamp 
until well heated. The rubber bulb at the end of 
the tube may then be compressed repeatedly and 
rather rapidly by the nurse until the point of the 



Fig. 66. 




Thermo Cautery (Paquelin's 



cautery becomes red hot. The vial containing 
benzine — or benzol, a cruder product of the same 
kind — should be kept at a safe distance from the 
lamp and from the red-hot point, as the fluid is 
inflammable. The vial is usually provided with a 



SPECIAL GYNAECOLOGICAL NURSING. 25 I 

hook, by which it may be fastened to a button-hole 
in the waist of the nurse's dress. One hand is then 
free for compression of the bulb and the other 
holds the cautery by its wooden handle. When 
the point of the cautery is red hot it may be re- 
moved from the flame of the lamp and the heat 
kept up by compression of the bulb, which forces 
the vapor of the benzol into -contact with the 
lower portion of the cautery. When the point 
seems to be getting cold rapid compression of the 
bulb will again heat it up. 

After the surgeon has finished with the use of 
the cautery it should be heated to a white heat by 
rapid compression of the bulb and the tubing 
pulled off the handle while it is still hot. Thi§ 
sudden cooling helps to preserve the point. The 
same instrument will sometimes be needed in the 
treatment of hemorrhoids — also for Cauterizing the 
stump in abdominal section. 

The after-treatment in a case of urethral carun- After-treat- 
cle is very simple. The patient should be kept 
quiet in bed for a few days, and the urine should 
be drawn off about once in six hours for the first 
day, after which the patient may pass it. It may 
not be necessary to use the catheter at all, should 
the patient be able to pass her water from the first. 

The use of some diluent drink will also aid in 
making the passage of urine less painful. 



252 



DISEASES OF WOMEN. 



Operations 
for hemor- 
rhoids. 



Dressings. 



Palliative" 
treatment 
for hemor- 
rhoids. 



After-care. 



Operations 
for stone 
in the 
bladder. 



After the removal of hemorrhoids or piles the 
patient often suffers considerably from swelling and 
throbbing pain. If but a portion of them have 
been removed the others may be temporarily much 
distended. Lint kept saturated with lead-water 
and laudanum, or some other soothing application, 
will frequently give great relief, as will the use of 
astringent and anodyne ointments prescribed by 
the surgeon. A T-bandage and antiseptic pad will 
need to be worn by the patient, and these will serve 
to hold the applications in place. 

For the relief of hemorrhoids preparatory to 
operation the application of cloths, wrung out in 
hot water, will serve to shrink them, and then, 
being anointed with vaseline or some simple oint- 
ment, they should be returned into the bowel. 

Care to secure movements which are soft in con- 
sistency will bb one of the chief objects in a nurse's 
attentions. The measures already described in the 
use of oil enemata, combined with a laxative, are 
most effectual. The patient's diet need not be 
restricted. She may need to be confined to bed 
from ten days to two weeks, according to the 
severity of the case. 

Lithotrity and lithotomy are operations for re- 
moval of stone from the bladder which are occa- 
sionally done through the urethra and vagina. 
The preparations for these, as for other pelvic 



SPECIAL GYNECOLOGICAL NURSING. 253 

operations, consist in free purgation and rest in 
bed for a day or two. After the operation all 
efforts will be needed to allay irritation. 

The patient must remain in bed, and mild drinks After - man - 

x ' agement. 

will probably need to be frequently administered, 
as flaxseed tea, barley water, soda water, milk, etc. 
The bed-pan and urinal after lithotrity (crushing of 
the stone) should be used, and all fragments of 
stone kept for the doctor's inspection. 

In lithotomy special provision will have to be 
made by means of pads for the protection of the 
bed from the dribbling of urine. Sometimes a tube 
is left in the wound for a few days, and the nurse 
will need to learn from the surgeon what he desires 
done to keep it free from obstruction. The nurse 
must make every effort to keep the patient quiet, 
clean, and dry. The hips and buttocks must be 
washed frequently and oiled, to prevent irritation 
from the constant escape of urine through the 
wound. 

Any appearance of blood in the urine must be symptoms 
reported to the surgeon, also any disposition to reported, 
chilliness, profuse perspiration, tenderness about 
the lower part of the abdomen, etc. 

Both these operations are done with the patient 
lying upon her back. 

The occurrence of abscess of the pelvis, which °P eratio " 

r for pelvic 

may point either externally or internally, sometimes a1 ? scess - 



Manage- 
ment of 
aspirators. 



254 



DISEASES OF WOMEN. 



demands the use of an apparatus known as the 
aspirator, which draws off the contents of the 
abscess by suction. A vacuum is produced in the 
bottle, as shown in the cut, by exhausting the air 
by means of the barrel and piston syringe. The 
return of air to the bottle being prevented by turn- 



Fig. 67. 




Aspirator and Needles. 



ing the small button on the side next the syringe 
to close off communication there, and the valve on 
the opposite side being opened by adjusting the 
button on the needle-side properly, a suction power 
is set up which draws out the contents of the 
abscess. A very thorough cleansing of the appara- 
tus is necessary after such use. 



SPECIAL GYNECOLOGICAL NURSING. 



255 



The management of the case afterward will be After-care, 
directed by the surgeon and will depend on the 
location of the opening if one is made. If in the 
vagina, antiseptic douches will be required. If an 
external opening, a daily washing out of the abscess 
cavity and re-dressing of the wound may be nec- 
essary. 



Fig. 68. 




Intra-uterine Return Catheter. 



Operations for dilatation and curetting of the Dilatation 

and curet- 

uterus, or removal of polypi or retained placenta, tin § ° f 
will need a similar preparation to that required for 
all pelvic operations. Especial care must be given 
to the employment of an antiseptic vaginal injec- 
tion just before operation. The patient will need 
to be placed in the lithotomy position. During 
the operation the uterus will probably need to be 



256 DISEASES OF WOMEN. 

Use of washed out. For this purpose the intra-uterine 

intra-uter- . r r . . - . . , 

ine syringe, syringe, one form 01 which is shown in the cut, 
may be employed. The lower figure shows the 
instrument as it is put together for use, the upper 
shows its separation into its three constituent parts. 
It may be thus more thoroughly cleansed and 
rendered a safer instrument for use in different 
cases. 

One end of a piece of flexible rubber tubing is 
slipped over the outer end of the catheter, and the 
other end over the nozzle connected with a foun- 
tain syringe. The solution used is contained in 
the rubber bag of the syringe, and, flowing down 
through the tubing and into one channel of the 
intra-uterine syringe, is carried into the uterus, 
being carried back through the other channel. 
Care must be taken in using these instruments to 
see that the return flow is free. If not, it may be 
possible that the instrument is clogged by a clot of 
blood or some shreds of tissue. It must then be 
removed and cleaned and reinserted. A thorough 
boiling or steaming of the instrument, after taking 
it apart, should follow its use. 
Vaginal Vaginal hysterectomy is an operation for the re- 

tomy. moval of the uterus through the vagina, and is 
most frequently done for cancer. 

The patient is prepared as for perineal operation 
and placed in the lithotomy position upon the 



SPECIAL GYNAECOLOGICAL NURSING. 257 

tabic, the limbs being held by the leg-holder. 
The after-management of the case will be depend- 
ent upon the methods preferred by the surgeon. 
If forceps are used to clamp the vessels, instead of 
ligatures being applied, they will extrude from the 
vagina, and the nurse will have to be careful in 
watching them to see that they do not loosen and 
drop off, and that there is no strain on them in the 
slight changes of position to which the patient may 
need to be subjected. In fact, the patient should 
be kept very quietly upon her back and all move- 
ments avoided until after the removal of the clamps, 
in two to three days. Quiet should be maintained 
after the removal of the clamps, to avoid the dan- 
ger of secondary hemorrhage, until the surgeon 
declares all danger past. Antiseptic pads should 
be kept beneath the patient and frequently 
changed. 

When ligatures are used a thick pad of iodoform 
wool or gauze is laid over the vulva, after the tam- 
poning of the vagina, and if a drainage-tube has* 
been inserted in the vagina a sponge may be 
placed over its mouth. These dressings will be 
frequently inspected by the surgeon and changed 
if necessary. When the drainage-tube is used the 
pelvic cavity may have to be washed out should the 
temperature rise high or the discharge become 
offensive. Extreme care as to thorough asepsis 
17 - 



258 DISEASES OF WOMEN. 

will need to be practiced. The ligatures as a rule 
come away of themselves. If not, the surgeon 
may remove any sutures he may have introduced, 
and the remaining ligatures, at the end of two 
weeks. The patient will have to be placed on a 
table in the lithotomy position for this, and a Sims 
speculum used to depress the perineum. 

As very especial danger of hemorrhage exists 
after this operation, extreme watchfulness will need 
to be exercised by the nurse in the care of a case 
of vaginal hysterectomy, and a frequent inspection 
should be made of the dressings to discover the 
amount and character of the discharge. 
Amputa- Operations on the breast may be done for the 

tion of the x J 

breast. removal of tumors or cancer. The' armpit must 
be shaved and the breast made thoroughly clean 
by soap and water, followed by ether or turpentine 
for removing the grease from the skin, and then 
a thorough cleansing with bichloride solution, 
1-1000. The breast is then carefully enveloped in 
antiseptic dressings until the time for operation. 
The patient is prepared as for other operations. 
When it is near the time for operation the clothing 
may be removed from the side to be operated upon, 
but not from the other. A thin sheet of rubber 
gossamer or, in a private house where this cannot 
be had, a folded sheet should go under the breast 
and arm of the affected side, being turned in over 



SPECIAL GYNAECOLOGICAL NURSING. 259 

the clothing and fastened upon the opposite 
shoulder toward the front by a shield-pin. 

The dressings should not be removed from the 
breast until the operator is ready to begin. If 
there is any delay a shawl or blanket can be thrown 
over the patient's shoulders until the surgeon is 
ready. 

The table for operation should be arranged as in other prc - 

, . , , . parations 

any other operation, except that the operating pad 
should be placed at the upper part of the table, 
under the affected shoulder. Sterilized towels may 
be placed over the rubber-cloth protecting the 
patient's clothing. Special dressings will need to be ? he ^ ss- 
prepared for the case; thus, a large antiseptic pad banda § es - 
which shall reach front and back to the median line 
of the body may be applied over the side of the 
chest whence the breast was removed, and this 
held in place by roller bandages firmly applied ; 
or, a straight bandage may hold the antiseptic 
dressings in place, and a second one be used to 
hold the arm firmly pinned down to the side. 
These bandages may be prevented from slipping by 
a strip of roller bandage fastened front and back 
to their upper edge and passing over the shoulder. 

The patient should be kept perfectly quiet after After . care 
the operation. A little pillow 8 x 10 inches, of 
down or feathers, may be slipped under the arm of 
the affected side to support it and keep it from 



260 DISEASES OF WOMEN. 

Watching dragging down. The nurse must watch especially 

rhages. for any tendency to hemorrhage. As the blood 
will naturally run under the patient's back, owing 
to her position, she must be gently lifted or rolled 
toward the opposite side from time to time and the 
back examined. Liquid food should be used for 
two or three days, unless the nurse is directed dif- 

?fwound ng ferently. Fresh dressings and bandages should be 
in readiness for the surgeon, as he may desire at 
any time to re-dress the wound. Should any dis- 
charge come through the dressings the surgeon 
should be at once notified of this, as it will be nec- 
essary in such case to change the dressings. The 
same antiseptic precautions should be observed in 
this re -dressing as in the original dressing of the 
wound. 

tne S b?eas°u Inflammation and abscess of the breast may 
sometimes occur as a result of injury or of over- 
distention of the breast with milk during lactation. 
In preparing for the operation of lancing the breast 
the nurse will need to cleanse the breast thoroughly 
and then wash it with an antiseptic solution and 
apply antiseptic dressings to keep it sterile until 
the time for operation. She should have in readi- 
ness a number of sterilized towels, a pus-pan or 
basin in which to catch the discharges, a tin basin 
containing carbolic solution for the instruments, an 
agate or china basin with a bichloride of mercury 



SPECIAL GYNAECOLOGICAL NURSING. 



26l 



solution for the doctor's hands, soap, nail-brush, 
etc. The patient's clothing should be arranged as 
for amputation of the breast. 

The instruments used will be the bistoury, 
straight or curved, and possibly a probe for subse- 
quent packing of the cavity, with a strip of iodo- 
form gauze. 

Should the surgeon wish to use local anaesthesia 
by means of ice and salt applied to the part, a bowl 




Bistouries, straight and curved. 



containing a small quantity of salt and a piece of 
smooth ice the size of a small fist, wrapped in a 
towel, so that it can be thus held by the surgeon 
while the application is made, should be provided. 
Antiseptic dressings may be applied to the part 
after lancing, or poultices may have, for a time, 
to be kept up. In the latter case the poultice 
should be made by mixing the meal with an an- 
tiseptic solution instead of plain water, in order 



262 DISEASES OF WOMEN. 

that as thorough asepsis as possible may be ob- 
served.* 

The abscess cavity will probably need to be 
washed out daily with an antiseptic solution and 
the breast re-dressed. 

ANESTHESIA. 

The administration of an anaesthetic, as ether or 
chloroform, does not often devolve upon the nurse ; 
occasionally, however, the physician is obliged to 
call upon the nurse to aid him in this direction ; it 
is therefore important that she should understand 
how to conduct the process. For general anaes- 
thesia ether is preferable to anything else, because 
it is much the safest anaesthetic known. Chloro- 
form is dangerous because of its direct action upon 
the heart. 

A patient should be prepared for etherization by 
taking nothing into the stomach for several hours 
previously. All the clothing should be loosened, 
false teeth should be removed and the patient 
placed in a recumbent posture. The patient may 
be made to feel less nervous by one's placing the 

* The better method of applying an antiseptic poultice, is to use 
several thick folds of antiseptic gauze wrung out in hot sterilized 
water, placing a piece of rubber tissue over this and binding in place 
by a bandage. This may be reapplied every two or three hours. 



SPECIAL GYNECOLOGICAL NURSING. 263 

inhaler or towel over her mouth without any ether 
upon it and teaching her to draw deep breaths for 
a few seconds. A small handkerchief, loosely 
folded, may be saturated with about an ounce (two 
tablespoonfuls) of ether and held over the patient's 
mouth and nose, a dry towel being held over this 
to prevent the evaporation of the ether. The eyes 
may be covered by this towel. -No talking should 
go on in the room, if possible, as the patient should 
be kept free from excitement. When inhalation 
has fully begun the ether cloth should not be 
removed from the patient's face, but more ether 
added by simply lifting the dry towel and adding 
the ether to the cloth beneath it. Should the 
patient stop breathing for a moment or the face 
become blue, the ether should be removed for a 
moment from the face. When a deep breath has 
been taken, the inhalation should be renewed. 
When during the stage of excitement the patient 
struggles and screams, the ether cloth should be 
held closely to the face, because giving her more 
air will simply make her noisier. The deep inspi- 
rations induced by crying and shouting often 
enable the inhalation to be more quickly effected. 
Retching is another symptom for which the ether 
should not be removed. If, however, the contents 
of the stomach are brought up into the throat and 
mouth, the etherization must be stopped until the 



264 DISEASES OF WOMEN. 

mouth and throat have been cleared, or there will 
be danger of choking. The ether should be stopped 
for just as short a time as possible. When the 
mouth and throat become filled with an excessive 
secretion of mucus, it is also necessary to stop for 
a time and clear this away by carrying the finger 
into the mouth or by turning the patient over for a 
moment on her face or letting her head hang down 
for a moment over the operating table. When the 
patient breathes heavily, the muscles are all 
relaxed, and on lifting the eyelid and touching the 
eyeball the patient does not flinch, etherization is 
complete and the operator will be able to begin his 
work. 

The ether will after this need to be administered 
in very small quantity. When the patient is 
breathing heavily, making a snoring sound (ster- 
torous breathing), the ether should not be pushed, 
but the towel held some distance from the face. 

Whenever ether is administered it should be 
remembered that its vapor is inflammable, and so 
heavy that it falls to the floor, so that any light, as 
a candle or alcohol lamp, should be placed at a 
distance from the operating table and on a higher 
level. 

When breathing ceases entirely and failure of the 
heart seems to threaten, the patient's body should 
be inverted, and stimulants, as digitalis, atropia, or 



SPECIAL GYNECOLOGICAL NURSING. 265 

aromatic spirit of ammonia, used hypodermically. 
Every effort should be made to get the patient to 
take a full breath. The tongue should be drawn 
forward out of the mouth,, the cheeks and chest 
slapped with a towel wrung out in cold water, arti- 
ficial respiration may be resorted to, or the use of 
electricity. 



THE NURSE S ARMAMENTARIUM. 

A few words may be said in this connection of 
the nurse's armamentarium — the articles she will 
need to take with her to assist in the management 
of the cases she nurses 

A little pocket-case, containing a clinical ther- 
mometer, straight scissors, sharp-pointed and 
blunt-pointed, a pair of anatomical forceps, a probe, 
a hypodermic syringe, and a female catheter, is a 
convenience. An English or French male catheter 
is, also, often a necessity. Besides these the nurse 
wall need a medicine glass, a feeder, and a nail- 
brush of her own ; possibly a wall thermometer or 
bath thermometer might be added to the list, as it 
may save her delay in the use of the douches, etc., 
as ordered, in case the family should not have any- 
thing of the kind. 

Careful written reports should be kept of each 
case she nurses, and some blanks with the proper 



266 DISEASES OF WOMEN. 

headings should be carried by her to each case. 
Thus properly equipped, she will be able to work 
more efficiently and satisfactorily to herself and to 
her patient. 



SPECIAL GYN/ECOLOGICAL NURSING. 



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DIET FOR THE SICK. 



LIQUID DIET. 

BARLEY WATER. 
To one tablespoonful of ground barley add a 
pint of cold water ; let it boil twenty minutes. 
Strain and keep in a cool place until used. 

TOAST-MILK. • 
Toast two slices of baker's bread a dark brown, 
after drying thoroughly in the oven ; boil a pint 
of milk and pour it over the toast ; strain and add 
either a little salt or sugar. Toast water is made 
in the same way, using water instead of milk. 

FLAXSEED TEA. 
To one quart of cold water add one tablespoon- 
ful of flaxseed; let simmer three or four hours; 
strain; add lemon juice and sugar to taste. 

WINE WHEY. 
When a pint of milk is brought just to a boil, 
pour in a gill of sherry wine ; let it again come 
to a boil ; when the whey separates, strain through 
gauze. It may be taken either warm or cold. 

268 



DIET FOR THE SICK. 269 

RICE WATER. 
Wash one ounce of rice with cold water, then put 
the washed rice and an inch of cinnamom stick into 
a double boiler with a pint of boiling water, boil 
for one hour, strain and sweeten to taste, or a little 
salt may be added. 

APPLE-WATER. 
Pare, core, and cut into pieces a large, juicy apple ; 
boil in a pint of water until the apple is tender 
enough to crush to a pulp ; strain the liquor and 
sweeten to taste. 

MILK-PUNCH. 

Sweeten a glass three parts full of new milk to 
taste and add one or two tablespoonfuls of brandy 
or whisky. 

EGG-NOG. 

Stir well a heaping teaspoonful of sugar and the 
yolk of an egg in a glass and then add a table- 
spoonful of brandy or whisky ; fill the glass with 
new milk until it is three parts full, then stir into 
the mixture the white of the egg beaten to a stiff 
froth. 

EGG-FLIP. 

One egg y four teaspoonfuls of sugar, a glass three 
parts full of new milk ; beat the egg and sugar 
together until light and stiff, then add to the milk. 



27O DISEASES OF WOMEN. 

TOAST-WINE. 

One slice of well-browned toast, half a pint of 
boiling water, one teaspoonful of sugar, two table- 
spoonfuls of wine ; put the toast into a pitcher, pour 
the boiling water over, and let stand until cold ; 
then strain off the water and to it add the sugar 
and wine. 

IMPERIAL DRINK. 

One pint of hot lemonade, one half teaspoonful 
of cream of tartar; dissolve the cream of tartar in 
the hot lemonade, strain and serve. 

EFFERVESCING DRINK. 
Juice of one lemon, one cup of cold water, sugar 
to taste, one half teaspoonful bicarbonate of soda. 
Drink while effervescing. 

ALBUMINIZED WATER. 
One pint of cold water, whites of two eggs, juice 
of one-half lemon, two teaspoonfuls of sugar; shake 
together, in a wide-mouthed jar with light fitting 
cover, until thoroughly mixed ; the sugar may be 
omitted; serve iced. 

ALBUMINIZED MILK. 
Shake together in a jar, one pint of milk, and 
whites of two eggs until thoroughly incorporated. 
It may be sweetened and flavored to taste. 



DIET FOR THE SICK. 2J\ 

LEMON WHEY. 
Warm one cup of milk, and add two tablespoon- 
fuls of lemon juice, boil together until the curd 
separates. Press the whey from the curd, add 
sugar to taste. Serve cold. 

TODDY. - 
Half a glass of water, either hot or cold, half a 
teaspoonful of sugar, four teaspoonfuls of brandy 
or whisky ; dissolve the sugar in the water and add 
the brandy or whisky. If the juice of a lemon be 
added it makes lemon-toddy. 

BEEF-TEA. 
To one pint of cold water add one pound of 
chopped lean beef; let boil slowly four hours ; strain 
and salt to taste. 

QUICK BEEF-TEA. 
One pound of chopped lean beef, half-a-pint of 
cold water, saltspoonful of salt ; put the meat, 
water, and salt in a closely covered pan and boil 
gently ten minutes ; stir well, strain, and remove 
the fat. 

BEEF-BROTH. 

One quart of cold water, one pound of lean, 
juicy beef; boil slowly for one hour ; add a table- 
spoonful of rice, and salt to taste ; when the rice is 



272 DISEASES OF WOMEN. 

tender, strain the broth and serve with strips of dry 
toast. 

Mutton broth is made in the same manner. 

Chicken broth requires three pounds of chicken 
to two quarts of cold water. 

CLAM BROTH. * 

Six large, hard -shelled clams, wash thoroughly 
free from sand, put into a kettle with two or three 
tablespoonfuls of water, cook until the clams open, 
strain through a cloth ; if too salt dilute with water 
or milk ; serve hot. 

OYSTER BROTH. 

Cut one pint of oysters into small pieces, put 
them into a saucepan with half a pint of cold water ; 
boil gently ten minutes ; skim, strain, and salt to 
taste. Serve hot with toasted crackers. 

Clam broth is made in the same way. 

EXPRESSED BEEF-JUICE. 
Broil or pan lean beefsteak until it is heated 
through; squeeze the juice out with either a beef 
press or a lemon squeezer; strain through gauze to 
get the fat off. Before serving warm the juice in a 
small cup placed inside a cup of boiling water. 

TO MAKE COFFEE. 
Mix one tablespoonful of ground coffee with 
enough cold water to form a paste ; add one half- 



DIET FOR THE SICK. 273 

pint of boiling water; boil a few minutes, then set 
it back on the ran^e for a few moments to settle. 



TO MAKE TEA. 
Allow one small teaspoonful of tea to every cup ; 
add boiling water. Let the teapot stand at the side 
of the fire without boiling for a short time. 

TO MAKE COCOA. 
Mix one teaspoonful of cocoa with enough boil- 
ing water to form a paste; add a cupful of boiling 
milk and serve immediately. 

EGG-BROTH. 
Beat an egg very light, add half teaspoonful of 
sugar and a little salt. Pour on it by degrees one 
pint of boiling water, stirring constantly to prevent 
curdling. 

KOUMISS. 
Fill a quart wine bottle up to the neck with pure 
milk ; add a quarter of a cake of compressed yeast 
and two tablespoonfuls of white sugar that have 
been dissolved in a little water over a hot fire. Tie 
the cork in the bottle securely and shake the 
bottle well. Place in a room of a temperature 
of from 50 to 90 F. for six hours, then in the ice- 
box over night. 
18 



274 DISEASES OF WOMEN. 

SEMI-LIQUID DIET. 

RICE-FLOUR GRUEL. 
Mix two teaspoonfuls of rice flour with four 
tablespoonfuls of cold milk ; pour this into one pint 
of boiling milk, stirring all the time ; boil gently 
for fifteen minutes ; add sugar or salt to taste. 



OATMEAL GRUEL. 
Stir slowly one-half a cupful of rolled oats into 
one pint of boiling water ; salt to taste and boil for 
twenty minutes. 

FARINA GRUEL. 
Sprinkle slowly one heaping tablespoonful of 
farina into one pint of boiling water, stirring all the 
time to prevent lumps ; boil for half an hour; add 
salt to taste. 

PLUM GRUEL. 

Two dozen raisins, seeded and cut into small 
pieces, two cups of boiling milk, one tablespoonful 
of flour. Boil the raisins until tender, let the water 
boil away ; add the boiling milk ; rub the flour to 
a thin paste with a little milk ; cook until thoroughly 
blended ; add a little salt or sugar, and strain. A 
well beaten egg may be added. 



DIET FOR THE SICK. 275 

MEAL BALL. 
Tie a pint of flour tightly in a piece of stout 
muslin and boil for nine hours ; scrape off the 
outer crust, and the inside will be found to be a dry- 
ball ; grate this as needed, allowing one table- 
spoonful wet in cold milk to a pint of boiling milk ; 
boil until smooth ; add a salt spoonful of salt. 

CORN-MEAL GRUEL. 
Stir two even tablespoonfuls of corn meal into 
one pint of boiling water; boil gently for half an 
hour ; salt to taste. 



PEPTONIZED FOODS. 

MILK PEPTONIZED BY HEAT. 
Into a clean quart bottle put one measure (5 
grs.) of Fairchild's Extractum Pancreatis, and one 
measure (15 grs.) of bicarbonate of soda, and a gill 
of cold water ; shake ; then add a pint of fresh, cold 
milk and shake the mixture again. Place the 
bottle in water about ioo° to 1 1 5 °, or so hot the 
whole hand can be held in it without discomfort 
for a minute. Keep the bottle there twenty 
minutes. At the end of that time put the bottle on 
ice to check further digestion and keep the milk 
from spoiling. Peptonized milk may be sweetened, 
flavored with grated nutmeg, or taken with mineral 



276 DISEASES OF WOMEN. 

water. Put the mineral water first into the glass, 
then quickly pour in the peptonized milk, and 
drink during effervescence. 

MILK PEPTONIZED BY COLD PROCESS. 
Mix the peptonizing powder in cold water and 
cold milk as usual, and immediately place the 
bottle on ice, without subjecting it to the water 
bath or any heat. When needed pour out the re- 
quired quantity and use in the same manner as 
ordinary milk. 

SPECIALLY PEPTONIZED MILK FOR JELLIES, 
PUNCHES, ETC. 

Mix the peptonizing powder (Extractum Pan- 
creatis and bicarbonate of soda), cold water, and 
milk in a bottle, and place in a hot-water bath, as 
directed in recipe for peptonizing milk ; let the 
bottle remain in the hot water for two hours, then 
pour into a saucepan and heat to boiling. This 
specially peptonized milk is now ready for jellies, 
etc. In peptonizing milk for recipes in which 
lemon juice or acid is to be used, it is necessary to 
carry the process to the point at which the milk 
will curdle with acid. Hence the two hours' diges- 
tion. Do not fail to boil the milk immediately 
after the two hours in water bath, otherwise the 
milk will not set into a jelly, as the powder would 
digest the gelatine. 



DIET FOR THE SICK. 277 

PEPTONIZED MILK JELLY. 
First take about half a box of Nelson's gelatine, 
and set it aside to soak in a teacupful of cold water 
until needed ; take one pint of specially peptonized 
milk heated hot; pare one lemon and one orange 
and throw the rinds into the specially prepared 
milk; squeeze the lemon and. orange juice into a 
glass, strain, and mix it with two or three table- 
spoonfuls of wine or brandy; add to the milk, stir- 
ring well; strain through gauze, and when cooled 
to a sirupy consistence, so as to be almost ready 
to set, pour into moulds and set in a cool place. 
Do not pour the milk into the moulds until it is 
nearly cool, otherwise it will separate in setting. 

PEPTONIZED MILK-PUNCH. 
Take a glass about one-third full of fine crushed 
ice, pour on it a tablespoonful of brandy or whisky, 
sweetened slightly and fill the glass with peptonized 
milk, stirring well. 

MILK LEMONADE. 
Take a glass one-third full of cracked ice; squeeze 
on it the juice of a lemon, sweeten to taste, and fill 
the glass with specially peptonized milk. 

MILK-GRUEL. 
Mix smoothly a heaping teaspoonful of wheat 
flour or arrowroot with half a pint of cold water ; 



278 DISEASES OF WOMEN. 

then heat, with constant stirring until it has boiled 
briskly, several minutes ; mix with this hot gruel 
one pint of cold milk, and strain into a jar and 
immediately add one peptonizing powder ; mix well. 
Let it stand in the hot water bath for 30 minutes, 
then put into a clean quart jar and place on ice. 

PEPTONIZED BEEF. 
One quarter of a pound of minced raw beef or 
beef and chicken mixed, or chicken alone ; cold 
water one-half pint ; cook over a slow fire, stirring 
constantly, until it has boiled a few minutes, then 
pour off the liquor and rub the meat to a paste, 
put it into a jar with one-half pint of cold water 
and the liquor poured from the meat, add four 
measures, or 20 grs., of Extractum Pancreatis, and 
one measure, or 15 grs., bicarbonate of soda ; shake 
all well together and set aside in a warm place at 
about no° or 1 1 5 ° F. for three hours, shaking 
occasionally, then boil quickly, strain and season. 
Be sure to boil the peptonized beef after three hours 
in a warm place, otherwise the digestion will pro- 
gress until it is spoiled. 

PEPTONIZED OYSTERS. 

Half a dozen large oysters with their juice and 

half a pint of cold water ; put into a saucepan and 

boil briskly for a few minutes ; strain off the broth 

and set aside ; mince the oysters and rub them to 



DIET FOR THE SICK. 279 

a paste ; now put the oysters in a glass jar with 
the juice which has been set aside, and add three 
measures, or 15 grs., of Extractum Pancreatis, and 
one measure, or 15 grs., of bicarbonate of soda ; 
let the jar stand in hot water, 115 F., for one and 
a half hours ; pour into a saucepan, add half a 
pint of milk, and heat over the fire slowly to boil- 
ing point ; strain, and season with salt and pepper. 
Heating the mixture slowly digests the milk suffi- 
ciently before the mixture boils. For a great 
majority of cases it will not be required to strain 
the peptonized liquor, for the portion of meat re- 
maining undissolved will have been so softened and 
acted upon by the pancreatic extract that it will be 
in very fine particles, and diffused in an almost 
impalpable condition. 

Farinaceous materials may also be used advan- 
tageously in the preparation of the peptonized soup 
by simply boiling a sufficient quantity of flour, 
arrowroot, rice, etc., with a half portion of the 
water used in the above recipe, and mixing all 
together, meat, gruel, Extractum Pancreatis, and 
soda. The pancreatine will at the same time digest 
both starch and meat. This has a more agreeable 
flavor than that made of meats alone. Jelly may 
also be made of peptonized beef. Beef-tea is pep- 
tonized in the same way as milk, using one pint of 
carefully strained cold beef-tea. 



280 DISEASES OF WOMEN. 



STERILIZED MILK. 



Place milk suitably diluted, sweetened and rein- 
forced by cream in a well scalded nursing bottle, 
cork the bottle with cotton, and place in a vessel 
containing four or five inches of cold water ; put the 
basin upon the fire. When the water begins to 
boil consult the clock, and let the boiling go on for 
ten minutes. Take from the fire and cool off for 
feeding. In scientific language we describe this 
process as heating milk and water in a carefully 
sterilized vessel to 156 F. for six minutes, but 
practically the simple plan described above has 
proved sufficient. 

Experience shows that the milk of the common 
red cow is superior, and that the milk of fine bred 
cows is more apt to contain tuberculosis bacilli, 
than is the milk of the common red cow. 

ARROWROOT CUSTARD. 

Mix four table-spoonfuls of Bermuda arrowroot 
with one gill of cold milk, and pour it slowly into 
one pint of boiling milk, stirring all the time ; add 
two teaspoonfuls of sugar, a pinch of salt, and cook 
for fifteen minutes ; flavor with nutmeg or ten 
drops of brandy ; pour in a mould to cool. Serve 
with cream. 



DIET FOR THE SICK. 28 1 

ARROWROOT WINE JELLY. 
Mix two tablespoonfuls of Bermuda arrowroot 
with four tablespoonfuls of cold water and strain 
through gauze into half a pint of boiling water, 
stirring all the time; add two teaspoonfuls of sugar 
and simmer for five minutes, or until it looks per- 
fectly clear; remove from the fire, and stir in two 
tablespoonfuls of wine or brandy. Pour into a 
mould to cool. 

CRACKER GRUEL. 
Two tablespoonfuls of fine cracker crumbs, Y / 2 
teaspoonful of salt, one cup of water, one cup of 
milk ; bring the milk and water to the boiling point, 
stir in the crumbs and salt; boil until smooth. 
Serve hot. 

ARROWROOT GRUEL. 
Mix one tablespoonful of Bermuda arrowroot, a 
pinch of salt, and half a gill of cold water; stir into 
half a pint of boiling water and boil for fifteen 
minutes. 

TAPIOCA JELLY. 

Wash one tablespoonful of tapioca thoroughly 
and soak it in three gills of cold water over night, 
then simmer slowly until clear ; add five teaspoon- 
fuls of sugar and two teaspoonfuls of lemon juice 
and turn into a mould. 



282 DISEASES OF WOMEN. 

TAPIOCA CUSTARD. 
One tablespoonful of tapioca soaked in two gills 
of cold water over night ; boil until clear ; put one 
gill of milk into a double kettle ; beat together one 
egg, one teaspoonful of sugar, one half teaspoonful 
of corn starch, and add to the gill of boiling milk; 
boil until about the consistence of cream ; take from 
the fire and pour it into a bowl to cool ; when cool 
stir in the stiff beaten white of an egg and the 
tapioca, and serve cold. Sago can be used in place 
of tapioca if desired. 

FARINA CUSTARD. 
Into two gills of boiling milk sprinkle one table- 
spoonful of farina, stirring all the time ; boil for 
twenty minutes ; then add the beaten yolk of one 
egg and one teaspoonful of sugar ; let boil again 
and stir in the stiff beaten white of the egg ; take 
from the fire, add a few drops of lemon or vanilla, 
if allowed, and turn out to cool. 



EASILY PREPARED DESSERTS FOR CONVALES- 
CENTS. 

RICE SNOW. 

Wash one tablespoonful of rice and boil until 

tender in a double boiler; add one tablespoonful 

of milk, one teaspoonful of sugar, a few drops of 



DIET FOR THE SICK. 283 

vanilla ; while boiling stir in the stiff beaten white 
of one egg. Serve with cream either hot or cold. 

BREAD PUDDING. 
Put one gill of dry bread crumbs into a small 
baking dish ; pour two gills of boiling milk over 
them, cover close, and set aside to cool ; beat 
together one heaping teaspoonful of sugar and one 
egg until very light, and stir into the bread and 
milk, which should be nearly cold ; flavor with 
nutmeg and bake in a quick oven for twenty 
minutes. Serve hot with cream. 

PLAIN RICE PUDDING. 
Wash one-third of a cup of rice well ; butter a 
pudding dish and stir in the rice, one pint of milk, 
and one tablespoonful of sugar ; add a pinch of salt ; 
grate nutmeg over it and bake for one and a half 
hours. 

CORN-STARCH PUDDING. 

Boil two gills of milk in a double kettle ; dis- 
solve one tablespoonful of corn-starch in a little 
cold milk and add to the boiling milk ; boil for five 
minutes and then add the beaten yolk of one egg, 
one teaspoonful of vanilla, and one tablespoonful of 
sugar; turn into a buttered dish and bake in the 
oven for fifteen minutes ; beat the white of the egg 
and a tablespoonful of pulverized sugar together 



284 DISEASES OF WOMEN. 

until very light, spread over the pudding, and 
brown lightly in the oven. Instead of adding the 
yolk and baking the pudding, after adding the 
sugar and flavoring, stir in the well-beaten white of 
the egg, turn into a wet cup, and serve in a custard 
made of the yolk in this way : into one gill of boil- 
ing milk stir one half teaspoonful of corn-starch 
dissolved in one tablespoonful of milk ; add the 
well-beaten yolk of the egg and one half teaspoon- 
ful of sugar ; boil for five minutes ; flavor with lemon 
or vanilla. 

TIPSY PUDDING. 
Half fill a small glass dish with stale sponge cake; 
mix together a tablespoonful of wine and table- 
spoonful of boiling water, and pour over the cake ; 
then fill the dish with custard made according to 
above recipe. 

GERMAN TRIFLES. 

In a small glass dish place a thin layer of sponge 
cake, then a layer of sliced orange, and pour custard 
over it. The white of the egg and one tablespoon- 
ful of pulverized sugar beaten very light may be 
piled on top when ready to serve. 

APPLE FLOAT. 
Stew and strain one large, tart apple ; when cold 
add a tablespoonful of sugar and the well-beaten 
white of one tgg. Serve as soon as made. 



DIET FOR THE SICK. 285 

APPLE CUSTARD. 
Stew and strain one large, tart apple; place over 
the fire, and while boiling add the beaten white of 
an egg and sugar to taste ; place on ice, and before 
serving pile the beaten white and pulverized sugar 
on top of the custard. Serve with cream. 

TAPIOCA AND FRUIT. 

Wash a tablespoonful of tapioca and soak over 
night in three gills of cold water ; then cook slowly 
until smooth and clear; add the juice of half a 
lemon, a teaspoonful of vanilla, and sugar to taste ; 
place about a dozen large strawberries in a dish 
and pour the hot tapioca over them ; then put on 
ice until ready to serve. Sliced peaches, rasp- 
berries, or bananas can be used in the same man- 
ner. 

EGG JUNKET. 

Beat one egg very light ; add one teaspoonful of 
sugar, one half teaspoonful of vanilla, and two gills 
of lukewarm milk ; put it into the dish it is to be 
served in and stir in one teaspoonful of rennet. 

CHOCOLATE PUDDING. 
Make a corn-starch pudding according to recipe 
given; when sufficiently boiled add one tablespoon- 
ful of grated chocolate ; put the white of egg beaten 
stiff with one tablespoonful of pulverized sugar on 
top and brown slightly in oven. 



286 DISEASES OF WOMEN. 

WHIPPED CREAM. 

Mix together two gills of rich cream, one-half 
cup pulverized sugar, two tablespoonfuls sherry 
wine ; put on ice for an hour, as cream whips much 
better if chilled; whip with an egg beater, and as 
the froth rises skim it off and lay it on a sieve to 
drain, returning the cream which drips away to be 
whipped over again. Place on the ice a short time 
before serving. 

LEMON JELLY. 

Cover one-third of a box of Nelson's gelatine 

with cold water and let it soak for fifteen minutes ; 

then add one cup of sugar, juice of one lemon, and 

two gills of boiling water ; stir until the sugar is 

dissolved ; strain through gauze and stand on ice 

to harden. 

WINE JELLY. 

Wine jelly is made the same, adding one gill of 
port or sherry wine instead of lemon juice. 

ORANGE FLOAT. 
Moisten one tablespoonful of corn-starch with a 
little cold water and stir it into two gills of boiling 
water, stirring constantly ; add one tablespoonful 
of sugar and the juice of one lemon; cut two 
oranges into small pieces, put into a dish, and pour 
the boiling corn-starch over them ; put on ice until 
needed. 



DIET FOR THE SICK. 287 

TOUT FAIT. 

Beat the yolk of an egg and a tablespoonful 
of sugar to a cream ; add one tablespoonful of 
milk and one of flour ; beat until smooth ; add 
the juice and rind of a lemon and the white of 
the egg beaten to a stiff froth ; turn into a but- 
tered cup, dredge the top of the custard thickly 
with pulverized sugar, and bake in a quick oven 
for fifteen minutes. 

STRAWBERRY SPONGE. 
Cover one-half box of Nelson's gelatine with cold 
water and soak for half an hour, then pour over 
it one pint of boiling water ; add one-half cup of 
sugar and stir until dissolved ; add one-half pint 
of strawberry juice and strain into a basin; put 
this basin into a pan of cracked ice to stand until 
cold and stiff, stirring occasionally ; then beat to 
a stiff froth, add the well-beaten whites of four 
eggs, beat until smooth ; then place on the ice to 
harden. 

CUP CUSTARD. 

Beat one egg until light ; add one teaspoonful ot 
sugar ; beat again ; add one and a half gills of milk 
and nutmeg to taste and stir until the sugar is dis- 
solved ; pour into a buttered cup, place the cup 
in a pan of boiling water, and place in the oven. 
Bake until the custard sets ; then set away to cool. 



288 DISEASES OF WOMEN. 

MISCELLANEOUS RECIPES. 

BAKED POTATOES 
Select potatoes of same size ; wash them well ; 
bake in a clean, hot oven from 30 to 40 minutes, 
or until soft; break the skins to let the steam in- 
side escape. Serve as soon as done. 

CROUTONS. 
Cut stale bread into half-inch slices ; cut off the 
crust and cut into half-inch cubes ; put them on a 
shallow pan and bake until brown. Use with beef- 
tea or broth. 

BAKED APPLES. 

Wipe the apples, remove the core, and put them 
in a pan; put sugar in the center of each apple 
and enough water to cover the bottom of the pan ; 
bake in a hot oven until soft, but not broken. 

BAKED CRACKERS. 
Split round crackers in halves, spread the inside 
with butter ; put them buttered side up into a pan 
and brown in a hot oven. 

BOILED POTATOES. 

Select potatoes of nearly same size; wash them 

well ; pare and cover with cold water; put them in 

a saucepan of boiling salted water (allowing one 

quart of water and one tablespoon even full of salt 



DIET FOR THE SICK. 289 

for six large potatoes) ; cook one-half hour or 
until soft ; drain off every drop of water and place 
the saucepan uncovered at the back of the stove 
to let the steam escape. Serve hot. 

RICE POTATO. 
Mash the potatoes as soon as they are boiled, 
and press them through a colander into a hot dish. 

RAW BEEF SANDWICH. 
Scrape a small piece of round steak, removing 
all fibers and connecting tissue; season slightly 
with salt and cayenne pepper, if allowed. Spread 
on thin slices of bread and butter, arrange as sand- 
wiches, and cut in narrow strips or shapes. Chopped 
parsley or a little fruit jelly may be mixed with 
the meat. 

MASHED POTATO. 
To one pint of hot boiled potatoes add one table- 
spoonful of butter, one-half teaspoonful of salt, and 
enough hot milk to moisten ; mash in the saucepan 
they were boiled in and beat with a fork until light 
and creamy ; then turn into a hot dish. 

POTATO CAKES. 
Make cold, mashed potatoes into small, round 
cakes about one-half inch thick ; put them into a 
baking pan, brush them over with milk, and bake in 
a hot oven until brown. 
19 



29O DISEASES OF WOMEN. 

HARD-BOILED EGGS. 
Cook them twenty minutes in water just bub- 
bling ; then the yolk is dry, mealy, and easily di- 
gested. 

BOILED CUSTARD. 

Beat one egg to a froth ; add one tablespoonful 
of sugar and a little salt ; mix well ; add one cup 
of scalded milk and stir over boiling water until it 
thickens. Serve cold. 

WATER TOAST. 
Dip a slice of dry toast in salted boiling water ; 
spread with butter and serve very hot. 

FRICASSEED OYSTERS. 
One cup of milk, one-half cup oyster liquor. When 
boiling add one teaspoonful of flour and one-half 
teaspoonful butter rubbed together; cook until it 
thickens, then add one dozen oysters ; cook until 
the oysters are plump and the edges curl ; serve 
immediately, plain or on toast. 

MILK TOAST. 
Dip a slice of dry toast in boiling milk which has 
a piece of butter dissolved in it. 

BROILED STEAK. 
Remove the bone and cut off the fat of a tender 
piece of steak ; broil over a clear fire, turning the 
broiler every ten seconds ; if it is to be rare, cook 



DIET FOR THE SICK. 29I 

for four minutes. Serve on a hot plate with but- 
ter, salt, and pepper. 

PANNED MUTTON CHOPS. 
Have the frying-pan hissing hot without any fat ; 
take off the pink skin and outer fat of a chop, put 
it in the pan, and cook one minute ; turn and sear 
on the other side, then cook more slowly until done 
— if rare, five minutes will be long enough ; when 
nearly done, sprinkle a little salt on each side. 
Drain on paper and serve very hot on a very hot 
plate without a drop of grease. 

BAKED APPLE SAUCE. 
Fill a small baking dish with apples, pared, cored, 
and quartered ; allow one-half cup of sugar for one 
quart of apples, also one cup of water ; bake, 
covered, in a slow oven until clear. 

CHICKEN CUSTARD. 
One cup chicken broth, beaten yolks of three 
eggs ; season with salt or celery salt ; one pint of 
milk ; add the milk slowly to the broth and eggs, 
put into a double boiler, and cook until thick, like 
cream. If the custard curdles, place in a pan of 
ice for a few minutes, and stir until smooth. 

STEWED PRUNES. 
Wash one pound of prunes and soak them for 
one hour before cooking ; put them in a granite 



292 DISEASES OF WOMEN. 

pan and cover with boiling water; simmer until 
swollen and tender, then add one tablespoonful of 
sugar ; cook ten minutes longer and set away to 
cool. 

STEWED OYSTERS. 

Put a pint of oysters in a pan and heat until the 
edges curl ; then add one cup of boiling milk that is 
salted to taste ; butter and pepper may be added if 
allowed. 

STEWED CRANBERRIES. 

Wash and pick one cup of cranberries ; put them 
in a saucepan and sprinkle one-half cup of sugar 
over them ; pour out one-fourth cup of water, and 
after they begin to boil cook them for ten minutes, 
closely covered ; do not stir them. They will jelly 
when cold and are much nicer than when strained. 

STEAMED RHUBARB. 

Wash enough rhubarb cut into inch pieces to 
fill a cup ; put it into a double boiler ; sprinkle one- 
half cup of sugar over it and steam until soft. Do 
not stir it. 

BROILED FISH. 

To broil mackerel, white fish, small blue fish, 
trout, small cod, shad, or any other thin fish, split 
them down the back and remove the head and tail. 
Sometimes it is well to remove the backbone also. 



DIET FOR THE SICK. 293 

To broil halibut, salmon, and other thick fish, cut 
them into inch-thick slices across the back-bone 
and remove the bone and skin. Oily fish need 
only salt and pepper, but dry white fish should be 
spread with soft butter before broiling. 

Grease a double wire broiler with lard or butter ; 
put the thickest edge of the fish next the middle 
of the broiler ; broil the flesh side first until it is 
brown, lifting it up often that it may not burn ; cook 
the other side enough just to crisp the skin — the 
time will vary with the thickness of the fish ; the 
flesh when done should look firm and white and 
separate easily from the bone ; loosen the fish from 
each side of the broiler, open the broiler and slide 
off the fish, or hold a plate over the skin side of 
the fish and invert plate and broiler together; season 
with pepper and salt. 

SAUCE FOR FISH. 
Put a pint of water in a saucepan ; add half-tea- 
spoonful of salt ; mix one-half cup of butter and 
two tablespoonfuls of flour together ; when per- 
fectly smooth, add to the boiling water, stir rapidly 
until it thickens — if not free from lumps strain the 
sauce. To make egg sauce, add to the drawn butter 
two hard-boiled eggs, sliced, or one tablespoonful 
of finely chopped parsley may be added. 



294 DISEASES OF WOMEN. 

SPONGE CAKE.. 
Four eggs beaten separately; yolks and one and 
one-half cups of sugar beaten together, one cup 
of flour beaten in ; then add one-half of the beaten 
whites and one cup of flour with one teaspoonful 
of baking powder sifted through it, then the remain- 
ing half of the beaten whites, and last one-half cup 
of boiling water beaten in ; turn quickly into a pan 
and bake in a quick oven for forty minutes. 



WEIGHTS AND MEASURES. 
FLUID MEASURE. 



m,6o 
fgviij 
fgxvj 
Oviij 



f3J 

Oj 

Cj. 



gr. xx 

B»j 

^viij 
S xi j 



APOTHECARIES' MEASURE. 



9J 
lb.j. 



DOMESTIC MEASURES. 
I teaspoonful, about one fluidrachm 
I tablespoonful, " y z fluidounce 
I wineglassful, " 2 fluidounces 
I teacupful, " 4 fluidounces 

1 coffeecupful, " 8 fluidounces 



f3J 

fgss 

fgiv 
fgviij. 



295 



ADDENDA, 



SUPPORTING TREATMENT OF ABDOMINAL SECTIONS. 



In view of the varied opinions of operators as to the line 
of treatment to be followed in the preparation and after- 
care of abdominal cases, I append the Directions to Nurses 
given by Dr. B. F. Baer, which embody briefly what may 
be termed the "supporting" plan of treatment;— 

Before Operation. — i. For forty-eight hours preceding 
operation the patient gets neither fruit, vegetables, nor milk. 
Diet will consist of broiled beefsteak, lamb chops, soft- 
boiled eggs, bread and butter, and coffee or tea. 

2. See that the patient gets a tub bath on the evening of 
the day on which you take charge, which will be two days 
before the operation. Follow this with a bichloride spong- 
ing, 1-4000, and then carefully look after the condition of 
nails, hair, 'umbilicus, etc., and see that all are perfectly 
clean. Put clean clothes on patient and bed after the bath, 

3. Two days before operation give half an ounce of sul- 
phate of magnesia at bed-time. If this does not move the 
bowels two or three times, another dose must be given before 
dinner on the next day. 

4. The night before operation the patient is given another 
tub bath, followed by a bichloride sponging, 1-3000, and a 
bichloride vaginal douche, 1-3000. 



SUPPORTING TREATMENT 

Day of Operation. — i. The patient remains in bed. If 
the operation is to take place at twelve o'clock or later, the 
patient must have a light breakfast at 7 a. m., consisting of 
a soft-boiled ^gg f a cup of tea or coffee, and one slice of 
bread and butter. 

2. At 8 A. M. give an enema of soapsuds. 

3. Then give a soap and warm water sponge bath, fol- 
lowed by another bichloride sponging, 1-3000. 

-4. After the bowels have been moved from the enema, 
give a bichloride douche, 1-3000. 

5. Give half an ounce of beef juice three hours before the 
operation. 

6. One hour before the time set for operation give half an 
ounce of whisky in two ounces of water. 

7. Repeat dose of whisky and water half an hour after 
first dose is given.* 

8. See that the patient has voided urine twenty minutes 
before the operation, or use catheter. 

9. Patient must be ready for etherization at least ten 
minutes before the time of operation, having artificial teeth 
removed, etc. 

After Operation. — 1. As soon as the patient is put to 
bed give a hypodermic injection of morphia, gr. %. ; atropia, 
gr. T J 7 , also a stimulating enema, as follows : — 

Whisky, one ounce ; 

Elix. valerianate of ammonia, half an ounce ; 

Hot water, five ounces. 



[* In the practice of this plan of treatment in the Woman's Hospital, it is 
customary to give a hypodermic injection of morphia and atropia in place of 
the whisky a half hour before operation. This enables the patient to take 
ether more quietly and prevents the filling up of the air passages with mucus. 
The hypodermic of morphia and atropia after operation is then not needed, 
as a rule.— A. M. F.] 



OF ABDOMINAL SECTIONS. 

2. Repeat the stimulating enema every four hours, as fol- 
lows : — 

Whisky, hilf an ounce ; 

Elix. valerianate of ammonia, two drachms ; 

Water? five ounces. 

To the fourth enema add one ounce of beef juice and re- 
duce the water to four ounces. Repeat the enema every 
four hours. 

3. The nurse must now take a seat beside the patient's 
bed and remain with her constantly until she has entirely 
recovered from the ether. During this time she must watch 
the respiration and pulse. If the patient vomits, see that 
her head is merely turned on the side, so as to prevent any 
vomited matter getting into the trachea. Take temperature, 
pulse, and respiration once in eight hours. 

4. If the patient seems very restless or has a good deal of 
pain, the second hypodermic of morphia and atropia should 
be given before midnight. 

5. If the patient desires to void her urine, let her do so in 
a urinal, but do not raise her on a bed pan. If she cannot 
void it herself, a catheter must be passed. Unless she de- 
sires it oftener, pass catheter every twelve hours until she 
can void urine spontaneously. 

6. About eighteen hours after operation give a teaspoonful 
of barley water if the stomach is quiet, and if this is retained 
repeat every hour for three hours, when it may be gradually 
increased one drachm with each dose. 

7. After four or five doses of barley water have been given 
and retained, give one teaspoonful of beef juice, and repeat 
this instead of barley water. If it agrees with the patient, 
this may be gradually increased after four or five doses have 
been given until half an ounce has been reached, when it 
should be repeated every two hours. If the patient vomits, 



SUPPORTING TREATMENT OF ABDOMINAL SECTIONS. 

discontinue nourishment by mouth for several hours. If the 
food by mouth is well retained, gradually increase the inter- 
vals between the rectal feedings until they are entirely dis- 
continued, which will not be until after the bowels have well 
moved and considerable nourishment is taken by mouth. 

8. If the patient desires it, a pillow may be placed under 
her knees about sixteen hours after the operation. 

9. Twenty-four hours after operation the patient may be 
turned on her side if she desires. 

10. In the evening of the next day after the operation begin 
with calomel and soda tablets (a quarter grain calomel and 
two grains soda) and give one every hour until eight have 
been.taken. At twelve o'clock midnight give half an ounce 
of sulphate of magnesia, unless the bowels have moved 
spontaneously. If the stomach is irritable or the patient 
has vomited the magnesia, give an enema at 7 A. M. of — 

Sulphate of magnesia, one ounce ; 
Glycerin, one ounce; 
Water, four ounces. 

In place of this enema two drachms of sulphate of magne- 
sia may be added to the feeding injections when the calomel 
is started. 

11. After the bowels have been well moved the patient 
can have light diet if she wishes, as a soft-boiled egg, a cup 
of tea or coffee, and a slice of bread and butter. But do 
not urge it upon her. 

12. The bowels must be moved daily. 

13. As a rule, the patient must not see her friends until 
the fifth or sixth day after the operation, and then only one 
member of the family. 

14. If complications arise, this routine is changed in ac- 
cordance with the surgeon's directions. 



INDEX. 



A BORTION, induction of, 182 
■**■ Abdominal section, causes for, 
45, 46 

preparation for, 94-102 

articles needed for, 60-62 

clothing needed for, 57 
Abstinence from food, 99, 225 
Anaesthesia, 262 
Antisepsis, definition of, 31 
Antiseptic solutions, 219 

strength of, 220 
Asepsis, definition of, 31 
Apple water, 268 
Apple float, 283 
Apple custard, 284 
Applicators, 198 
Armamentarium, 265 
Arnold steam sterilizer, 34 
Arrowroot custard, 279 

gruel, 280 

wine jelly, 280 
Aspirator, 254, 255 



TD ACTERIA, definition of, 25 
"■-^ diseases due to, 26 

growth of, 26 

pyogenic, 29 

security against, 29 

uses of, 29 

varieties of, 27 
Barley water, 267 
Baked apples, 287 

crackers, 287 

potatoes, 287 

apple sauce, 290 
Beef tea, 270 

broth, 270 

juice expressed, 271 
Bandage, abdominal, 142, 143 

many-tailed, 82, 83 

" T/' 221 
Bed, arrangement of, 58, 59 

warming of, 67, 11 1 



Bedding, changing of, 138-141 

Bed-pan, 130 

Bed-cradle, 156 

Bedsores, prevention of, 132 

Bathing, 187, 226 

after operation, 137 
Bladder, washing out of, 164 

care of, 180 

evacuation of, 98 
Boiled custard, 289 

potatoes, 287 
Broiled steak, 289 

fish, 291 
Breast, abscess of, 260, 261 

amputation of, 258, 259 

care after, 260 
Breath, care of, 23 
Broth, clam, 271 

egg, 272 



CARRIERS, 88 
Catheter, use of, 102, 124, 125 

return, 165 

S-shaped, 245 

bulbous, 246 
Catheterization, 237 
Carunculas myrtiformes, 170 
Caruncle, urethral, operation for, 249 
Care of soiled clothing, 112 

after minor operations, 233 
Clothing for minor operations, 226 

changing, 137 
Clitoris, 168 
Cleanliness, surgical, 19 

personal, 19 
Conception, 174 

prevention of, 182 
Costume of nurse, 19-21 
Counter-irritation, 198, 199 
Curetting of uterus, 255 
Cystitis, 163, 164, 248 
Convalescents, desserts for, 281-286 
Chocolate pudding, 286 



297 



298 



INDEX. 



Corn starch pudding, 282 
Cup custard, 286 
Coffee, to make, 271 
Cocoa, to make, 272 
Custard, chicken, 290 



T"\IET for sick, 267-293 
• L-/ liquid, 267-272 

semi-liquid, 273, 274 

after operations, 122, 123 

management of, 185, 186 
Dilatation of uterus, 255 
Disease, pelvic, 175 

causes of, 175-182 

management of, 184 

symptoms of, 184 

history of, 201, 202 
Disinfection of clothing, 19-21, 36 

of discharges, 37 

of furniture, 38 

of hands, 19-22, 101, 102 

of patient, 39, 96 

of room, 37, 38 

of waste matter, 36 

of wounds, deep, 35 
open, 39 
surface, 35 

of vagina, 226 

of vulva, 226 
Discharge, vaginal, 235 
Domestic measures, 294 
Drainage tube, 134 

capillary, 86, 136 

method of, 134, 136 
Dressings, surgical, 40 

special, 81 

application of, 236 
Drying powders, 81, 82 
Duties of nurse during operation, 114- 
116, 230, 231 

after operation, 114, 233, 267 
Drink, imperial, 269 

effervescing, 269 



PGG FLIP, 268 
■*-"' junket, 284 

nog, 268 
Electricity, 188 
Elytrorrhaphy, 241 
Embolism, 161 
Enemata, stimulating, 117 

moving, 128, 129 
Examination, preparation for, 201-204 

instruments for, 206-210 
Exercise, 187 



PARINA CUSTARD, 281 
■*■ Fever cot, 147 
Fistula, definition of, 243 

examination for, 244 

healing of, 244 

symptoms of, 244 

varieties of, 243, 244 

vesico-vaginal, 244 

operation for, 244 

care after, 245-247 

secondary operation, 248 

recto-vaginal, 248 

operation for, 248, 249 
Flaxseed tea, 267 
Forced feeding, 185 
Forceps, cyst, 91 

dressing, 209 

pressure, 89 

*'T," 91 
Fourchette, 170 
Furniture, arrangement of, 56, 57 

muffling of, 59, 60 

sterilization of, 38 



GAUZE, bichloride, 40, 41 
iodoform, 80, 81 

storing of, 81 
Genitalia, external, 168 

internal, 168 
Germicides, 35 
German trifles, 283 
Grooved director, 89 
Gruel, cornmeal, 274 

farina, 273 

oatmeal, 273 

rice flour, 273 

plum, 273 



HANDS, care of, 21 
Hard-boiled eggs, 289 
Hair, arrangement of, 97 
Hemorrhage, period of danger, 120 

internal, 157 

primary, 120, 157 

management of, 157, 158 

secondary, 120 

symptoms of, 120, 157 
Hemorrhoids, operation for, 252, 253 

care after, 252 

palliative treatment of, 252 
Hygiene, 175, 176 
Hymen, 170 
Hysterectomy, 48 

vaginal, 256, 257 



INDEX. 



299 



TCE CAP, Thornton's, 150 
**■ rubber, 147 
Ignition tubes, 86 
Inhibitory agents, 35 
Injections, vaginal, 94, 190 

antiseptic, 98 

method of giving, 118, 119, 190, 
196 
Instruments for abdominal section, 

8 9"93 
pelvic examination, 197-199 
Intra-uterine syringe, 255, 256 
Irrigation, 68, 69 
Irrigator, 195 
Infection, 28 
Inflammation, 120 



T70UMISS, 272 

•**• Kidneys, improper action of, 
165 



T ABIA, 168 
■*-" / Leg holder, 227 
Leiter's tubes, 149 
Lemon jelly, 285 
Ligament, broad, 172 
Ligature, definition of, 84 

material for, 84 

passage of, 166 

preparation of, 85, 86 

sterilization of, 84 

storing of, 84 



MASSAGE, 188 
Meatus, 168 
Measure, apothecaries, 294 

fluid, 294 

domestic, 294 
Meal ball, 274 
Menstruation, 166, 173 

suppressed, 169 
Milk, albuminized, 269 

punch, 268 

sterilized, 279 
Mons veneris, 168 



TSJEEDLE HOLDER, 88 
•^ Needles, threading, 88 
Nervous overstrain, 181 
Nurse, qualifications of, 17 

necessity for training, 18 
Nymphae, 168 



QBSTRUCTION, intestinal, 158 
^ prevention of, 158 

treatment of, 158 
Occlusion dressing, 222, 223 
Office oven, 32 
Orange float, 285 
Oyster broth, 271 
Operations on bladder, 51 

on gall-bladder, 50 

intestines, 49, 50 

kidneys, 50 

liver, 50 

mesentery, 51 

omentum, 51 

pancreas, 51 

spleen, 50 

stomach, 49 

tubes and ovaries, 48 

uterus, 48, 49 

pelvic, 215, 267 

minor preparations for, 215 
preparations, table for, 216 
arrangement of bed for, 216, 
217 

for pelvic abscess, 253, 254 

for stone in bladder, 252, 253 
Ovaries, 172 
Oysters, fricasseed, 289 



PANNED MUTTON CHOP, 290 
■*■ Peptonized foods, 274-278 
milk (hot process), 274 
(cold process), 275' 
for jellies, etc, 275 
for gruel, 276 
jelly, 276 
lemonade, 276 
punch, 276 
beef, 277 
oysters, 277 
Parotitis, 162 
Pedicle ligature, 88 
needle, 92 
pins, 93 
Perineum, 170 
Perineorrhaphy, 234 
preparation for, 234 
arrangement for, 235,' 
after care, 236, 237 
removal of sutures in, 240 
Peritonitis, symptoms of, 152 

treatment of, 155 
Pessaries, 198 
Phlegmasia, 160 
Position, 212, 213 
dorsal, ^27 
knee-chest, 229 



300 



INDEX. 



Position, Sims's, 212 
Puberty, 173, 174 
Pyaemia, 152 
Protection of patient, 228 
Potato cakes, 288 

mashed, 288 
Pudding, plain rice, 282 

bread, 282 • 

\D ECORD OF TEMPERATURE, 
■*^ 121 

special symptoms, 121-128 
Reform dress wear, 177-179 
Retractor, 92 
Rice potato, 288 

snow, 281 
Room, arrangement of, 56, 57 

fumigation of, 54, 56 

location of, 52, 53 

preparation of, 52-60 
Rules for preparing solutions, 42-44. 

to be observed in operations, 105- 
109 

O ALINE PURGATIVE, 95 
*^ Sauce for fish, 292 
Scalpels, 89 
Septicaemia, 152 

symptoms of, 152 

treatment of, 153 
Serre-nceud, 92 
Shock, 114, 115 
Sleep, 188 
Sound, uterine, 206 
Specula, 206 

bivalve, 206, 207 

cylindrical, 207 
Speculum,_Sims's, 208 
Sponges, artificial, 76 

diseased, 72 

discolored, 74 

counting, 75 

flat, 75, 7 6 

mounted, 75, 230 

preparation of, 72-74 

storing of, 74 

varieties of, 71 

management of, in, 231 
Stomach, washing out, 153 
Sterilization of bedding, 37 

clothing, 31, 57, 79 

instruments, 32, 40 

ligatures, 84, 85 

living tissues, 34 

water, 34 

by use of antiseptics, 79 
dry heat, 76 
moist heat, 76 



Stitch abscesses, 159 
Surgical apron, 104 
Syringe, hypodermic, 115 

care of, 116 
Syringe, use of, 116 

Davidson's, 118 

fountain, 191 
Steamed rhubarb, 291 
Stewed cranberries, 291 

oysters, 291 

prunes, 290 
Strawberry sponge, 286 
Sponge cake, 293 

HpAMPON, vaginal, 196, 197 
•*■ Tetanus, 165 
Thrombosis, 160, 161 
Temperature, rise of, 146 

reduction of, 146-147 
Thermo-cautery, 250, 251 
Trachelorrhaphy, 241 

preparation for, 242 

after care, 243 
Trismus, 166 
Trocar and cannula, 90 
Tubes, Fallopian, 172, 

drainage, 134 
Tapioca and fruit, 284 

custard, 281 

jelly, 280 
Tea, to make, 272 
Toast milk, 267 

wine, 269 
Tout fait, 286 
Tipsy pudding, 283 
Toddy, 270 
Trendelenburg position, 63 

TTRETER, closure of, 248 
^ Urine, character of, 126 

Urinals, 125, 126 

Uterus, 161, 171, 172 

T7AGINA, 169 
v Vestibule, 168 
Volsella, 90 
Vomiting after ether, 127 

TX7ATER COILS, 151 

^ * albuminized, 269 
Weights and measures, 294 
Whites, 171 

Wounds, redressing, 260 
Water toast, 289 
Whipped cream, 285 
Wine jelly, 285 
Wine whey, 267 
Whey, lemon, 270 



CATALOGUE No. 7. APRIL, 1893. 

A CATALOGUE 

OF 

Books for Students. 

INCLUDING THE 

? QUIZ-COMPENDS ? 



CONTENTS. 



paoe PAGE 
New Series of Manuals, 2,3,4,5 Obstetrics 10 



Anatomy, 
Biology, 
Chemistry, . 
Children's Diseases, 
Dentistry, 
Dictionaries, 
Eye Diseases, 
Electricity, . 
Gynaecology, 
Hygiene, 
Materia Medica, . 



6 Pathology, Histology, 

11 Pharmacy, . . . .12 

6 Physical Diagnosis, . . 11 

7 Physiology, . . . .11 

8 Practice of Medicine, . 11, 12 
16 j Prescription Books, . . 12 

8 I ?Quiz-Compends ? . 14,15 

9 Skin Diseases, . . .12 
10 i Surgery and Bandaging, . 13 

9 I Therapeutics, . . .9 

9 ; Urine and Urinary Organs, 13 



Medical Jurisprudence, . 10 j Venereal Diseases, . . 13. 
Nervous Diseases, 



PUBLISHED BY 

P. BLAKISTON, SON & CO., 

Medical Booksellers, Importers and Publishers. 

LARGE STOCK OF ALL STUDENTS' BOOKS, AT 
THE LOWEST PRICES. 

1012 Walnut Street, Philadelphia. 



*** For sale by all Booksellers, or any book will be sent by mail r 
postpaid, upon receipt of price. Catalogues of books on all branches 
of Medicine, Dentistry, Pharmacy, etc., supplied upon application. 

Price 1 rodents } 3 °°° Q uestions on Medical Subjects. 



" An excellent Series of Manuals." — Archives of Gynecology. 

A NEW SERIES OF 

STUDENTS' MANUALS 

On the various Branches of Medicine and Surgery. 

Can be used by Students of any College. 

Price of each, Handsome Cloth, $3.00. Full Leather, $3.50 

The object of this series is to furnish good manuals 
for the medical student, that will strike the medium 
between the compend on one hand and the prolix text- 
book on the other — to contain all that is necessary for 
the student, without embarrassing him with a flood of 
theory and involved statements. They have been pre- 
pared by well-known men, who have had large experience 
as teachers and writers, and who are, therefore, well 
informed as to the needs of the student. 

Their mechanical execution is of the best — good type 
and paper, handsomely illustrated whenever illustrations 
are of use, and strongly bound in uniform style. 

Each book is sold separately at a remarkably low 
price, and the immediate success of several of the 
volumes shows that the series has met with popular 
favor. 

No. 1. SURGERY. 318 Illustrations. 

Third Edition. 
A Manual of the Practice of Surgery. By Wm. J. 

Walsham, m.d., Asst. Surg, to, and Demonstrator of 

Surg, in, St. Bartholomew's Hospital, London, etc. 

318 Illustrations. 

Presents the introductory facts in Surgery in clear, precise 
language, and contains all the latest advances in Pathology, 
Antiseptics, etc. 

" It aims to occupy a position midway between the pretentious 
manual and the cumbersome System of Surgery, and its general 
character may be summed up in one word — practical." — The Medi- 
cal Bulletin. 

"Walsham, besides being an excellent surgeon, is a teacher in 
its best sense, and having had very great experience in the 
preparation of candidates for examination, and their subsequent 
professional career, may be relied upon to have carried out his 
work successfully. Without following out in detail his arrange- 
ment, which is excellent, we can at once say that his book is an 
embodiment of modern ideas neatly strung together, with an amount 
of careful organization well suited to the candidate, and, indeed, to 
the practitioner." — British Medical Journal. 

Price of each Book, Cloth, $3.00 ; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 2. DISEASES OF WOMEN. 150 Illus. 

NtW EDITION. 

The Diseases of Women. Including Diseases of the 
Bladder and Urethra. By Dr. F. Winckel, Professor 
of Gynecology and Director of the Royal University 
Clinic for Women, in Munich. Second Edition. Re- 
vised and Edited by Theophilus Parvin, M.D., 
Professor of Obstetrics and Diseases of Women and 
Children in Jefferson Medical College. 150 Engrav- 
ings, most of which are original. 
" The book will be a valuable one to physicians, and a safe and 

satisfactory one to put into the hands of students. It is issued in a 

neat and attractive form, and at a very reasonable price." — Boston 

Medical and Surgical Journal , 

No. 3. OBSTETRICS. 227 Illustrations. 
A Manual of Midwifery. By Alfred Lewis Galabin, 
M.A., M.D., Obstetric Physician and Lecturer on Mid- 
wifery and the Diseases of Women at Guy's Hospital, 
London; Examiner in Midwifery to the Conjoint 
Examining Board of England, etc. With 227 Illus. 
" This manual is one we can strongly recommend to all who 
desire to study the science as well as the practice of midwifery. 
Students at the present time not only are expected to know the 
principles of diagnosis, and the treatment of the various emergen- 
cies and complications that occur in the practice of midwifery, but 
find that the tendency is for examiners to ask more questions 
relating to the science of the subject than was the custom a few 
years ago. * * * The general standard of the manual is high ; 
and wherever the science and practice of midwifery are well taught 
it will be regarded as one of the most important text-books on the 
subject." — London Practitioner. 

No. 4. PHYSIOLOGY. Fifth Edition. 

321 ILLUSTRATIONS AND A GLOSSARY. 

A Manual of Physiology. By Gerald F. Yeo, m.d., 
f.r.cs., Professor of Physiology in King's College, 
London. 321 Illustrations and a Glossary of Terms. 
Fifth American from last English Edition, revised and 
improved. 758 pages. 

This volume was specially prepared to furnish students with a 
new text-book of Physiology, elementary so far as to avoid theories 
which have not borne the test of time and such details of methods 
as are unnecessary for students in our medical colleges. 

"The brief examination I have given it was so favorable that I 
placed it in the list of text-books recommended in the circular of the 
University Medical College." — Prof. Lewis A. Stimson, m.d., 
57 East 33d Street, New York, 

Price of each Book, Cloth, $3.00; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 5. DISEASES OP CHILDREN. 

SECOND EDITION. 
A Manual. By J. F. Goodhart, m.d., Phys. to the 
Evelina Hospital for Children; Asst. Phys. to 
Guy's Hospital, London. Second American Edition. 
Edited and Rearranged by Louis Starr, m.d., Clinical 
Prof, of Dis. of Children in the Hospital of the Univ. 
of Pennsylvania, and Physician to the Children's Hos- 
pital, Phila. Containing many new Prescriptions, a list 
of over 50 Formulae, conforming to the U. S. Pharma- 
copoeia, and Directions for making Artificial Human 
Milk, for the Artificial Digestion of Milk, etc. Illus. 

" The author has avoided the not uncommon error of writing a 
book on general medicine and labeling it ' Diseases of Children/ 
but has steadily kept in view the diseases which seemed to be 
incidental to childhood, or such points in disease as appear to be so 
peculiar to or pronounced in children as to justify insistence upon 
them. * * * A safe and reliable guide, and in many ways 
admirably adapted to the wants of the student and practitioner." — 
American Journal of Medical Science. 

No. 6. MATERIA MEDICA, PHARMACY, 
PHARMACOLOGY, AND THE- 
RAPEUTICS. 

JUST READY. 
A Handbook for Students. By Wm. Hale White, 
m.d., F.R.C.P., etc., Physician to, and Lecturer on Ma- 
teria Medica, Guy's Hospital; Examiner in Materia 
Medica, Royal College of Physicians, London^ etc. 
American Edition. Revised by Reynold W. Wilcox, 
m.a., m.d., Prof, of Clinical Medicine at the New York 
Post-Graduate Medical School and Hospital ; Assistant 
Visiting Physician Bellevue Hospital. 580 pages. 
In preparing this book, the wants of the medical student of to-day 
have been constantly kept in view. The division into several sub- 
jects, which are all arranged in a systematic, practical manner, will 
be found of great help in mastering the whole. The work of the 
editor has been mainly in the line of adapting the book to the use 
of American students ; at the same time, however, he has added 
much new material. Dr. Wilcox's long experience in teaching 
and writing on therapeutical subjects particularly fits him for the 
position of editor, and the double authorship has resulted in mak- 
ing a very complete handbook, containing much minor useful in- 
formation that if prepared by one man might have been overlooked. 

Price of each Book, Cioth, $3.00 ; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 7. MEDICAL JURISPRUDENCE AND 
TOXICOLOG-Y. 

THIRD REVISED EDITION. 
By John J. Reese, m.d., Professor of Medical Jurispru- 
dence and Toxicology in the University of Pennsyl- 
vania ; President of the Medical Jurisprudence Society 
of Phila. ; Third Edition, Revised and Enlarged. 

11 This admirable text-book." — Amer.Jour. of Med. Sciences. 

" We lay this volume aside, after a careful perusal of its pages, 
with the profound impression that it should be in the hands of every 

doctor and lawyer. It fully meets the wants of all students 

He has succeeded in admirably condensing into a handy volume all 
the essential points." — Cincinnati Lancet and' Clinic. 

No. 8. DISEASES OF THE EYE. 176 Illus. 

FOURTH EDITION. JUST READY. 

Diseases of the Eye and their Treatment. A Handbook 
for Physicians and Students. By Henry R. Swanzy, 
a.m., m.b., f.r.c.s.l, Surgeon to the. National Eye and 
Ear Infirmary ; Ophthalmic Surgeon to the Adelaide 
Hospital, Dublin; Examiner in Ophthalmic Surgery 
in the Royal University of Ireland. Fourth Edition, 
Thoroughly Revised. 176 Illustrations and a Zephyr 
Test Plate. 500 pages. 

" Mr. Swanzy has succeeded in producing the most intellectually- 
conceived and thoroughly executed resume of the science within 
the limits he has assigned himself. As a 'students' handbook/ 
small in size and moderate in price, it can hardly be equaled." — 
Medical News. 

"A full, clear, and comprehensive statement of Eye Diseases 
and their treatment, practical and thorough, and we feel fully jus- 
tified in commending it to our readers. It is written in a clear and 
forcible style, presenting in a condensed yet comprehensive form 
current and modern information .that will prove alike beneficial to 
the student and general practitioner." — Southern Practitioner. 

No. 9. MENTAL DISEASES. 

WITH ILLUSTRATIONS. JUST READY. 

Lectures on Mental Diseases, designed for Medical Stu- 
dents and General Practitioners. By Henry Putnam 
Stearns, a.m., m.d., Physician Superintendent at the 
Hartford Retreat, Lecturer on Mental Diseases in Yale 
University, New Haven, Conn., Hon. Mem. British 
Psycho. Asso'n, etc. With Illustrations and a Digest of 
the Laws of the various States relating to the Commit- 
ment and Care of the Insane. 636 pages. 

Price of each Book, Cloth, $3.00; Leather, $3.50. 



6 STUDENTS' TEXT-BOOKS AND MANUALS. 

ANATOMY. 

Morris' New Text-Book on Anatomy. Now Ready. By 
ten leading Surgeons and Anatomists, and Edited by Henry 
Morris, f.r.c.s. 791 Specially Engraved Illustrations, 214 of 
which are printed in colors. Octavo. 1280 pages. 

Price in Cloth, 7.50 ; Sheep, 8.50 ; Half Russia, 9.50. 
*#* Send for Descriptive Circular and Sample Pages. 

Macalister's Human Anatomy. 816 Illustrations. A new 
Text-book for Students and Practitioners, Systematic and Topo- 
graphical, including the Embryology, Histology, and Morphology 
of Man. With special reference to the requirements of 
Practical Surgery and Medicine. With 816 Illustrations, 
400 of which are original. Octavo. Cloth, 7.50; Leather, 8.50 

Ballou's Veterinary Anatomy and Physiology. Illustrated. 
By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New 
York College of Veterinary Surgeons. 29 graphic Illustrations. 
i2mo. Cloth, 1. 00; Interleaved for notes, 1.25 

Holden's Anatomy. A manual of Dissection of the Human 
Body. Fifth Edition. Enlarged, with Marginal References and 
over 200 Illustrations. Octavo. 

Bound in Oilcloth, for the Dissecting Room, $4.50. 

Holden's Human Osteology. Comprising a Description of the 
Bones, with Colored Delineations of the Attachments of the 
Muscles. The General and Microscopical Structure of Bone and 
its Development, With Lithographic Plates and Numerous Illus- 
trations. Seventh Edition. 8vo. Cloth, 6.00 

Holden's Landmarks, Medical and Surgical. 4th ed. Clo., 1.25 

Potter's Compend of Anatomy. Fifth Edition. Enlarged. 
16 Lithographic Plates. 117 Illustrations. See page 14. 

Cloth, 1. 00; Interleaved for Notes, 1.25 

CHEMISTRY. 

Bartley's Medical Chemistry. Second Edition. A text-book 
prepared specially for Medical, Pharmaceutical, and Dental Stu- 
dents. With 50 Illustrations, Plate of Absorption Spectra and 
Glossary of Chemical Terms. Revised and Enlarged. Cloth, 2,50 

Trimble. Practical and Analytical Chemistry. A Course in 
Chemical Analysis, by Henry Trimble, Prof, of Analytical Chem- 
istry in the Phila. College of Pharmacy. Illustrated. Fourth 
Edition, Enlarged. 8vo. Cloth, 1.50 

Bloxam's Chemistry, Inorganic and Organic, with Experiments. 
Seventh Edition. 281 Illustrations. Cloth, 4.50; Leather, 5.50 
MS" See pages 2 to j for list of Students' Manuals . 



STUDENTS' TEXT-BOOKS AND MANUALS. 7 

Chemistry : — Continued. 

Richter's Inorganic Chemistry. Fourth American, from Sixth 
German Edition. Translated by Prof. Edgar F. Smith, ph.d. 
89 Wood Engravings and Colored Plate of Spectra. Cloth, 2.00 

Richter's Organic Chemistry, or Chemistry of the Carbon 
Compounds. Illustrated. Second Edition. Cloth, 4.50 

Symonds. Manual of Chemistry, for the special use of Medi- 
cal Students. By Brandreth Symonds, a.m., m.d., Asst. 
Physician Roosevelt Hospital, Out-Patient Department ; Attend- 
ing Physician Northwestern Dispensary, New York. Cloth, 2.00 

Leffmann's Compend of Chemistry. Inorganic and Organic. 
Including Urinary Analysis. Third Edition. Revised. 
See Page 15. Cloth, 1. 00; Interleaved for Notes, 1.25 

Leffmann and Beam. Progressive Exercises in Practical 
Chemistry. i2mo. Illustrated. Cloth, 1.00 

Muter. Practical and Analytical Chemistry. Fourth Edi- 
tion. Revised, to meet the requirements of American Medical 
Colleges, by Prof. C. C. Hamilton. Illustrated. Cloth, 2.00 

Holland. The Urine, Common Poisons, and Milk Analysis, 
Chemical and Microscopical. For Laboratory Use. Fourth 
Edition, Enlarged. Illustrated. Cloth, 1.00 

Van Niiys. Urine Analysis. Illus. Cloth, 2.00 

CHILDREN. 

Goodhart and Starr. The Diseases of Children. Second 
Edition. By J. F. Goodhart, m.d., Physician to the Evelina 
Hospital for Children; Assistant Physician to Guy's Hospital, 
London. Revised and Edited by Louis Starr, m.d., Clinical 
Professor of Diseases of Children in the Hospital of the Univer- 
sity of Pennsylvania; Physician to the Children's Hospital, 
Philadelphia. Containing many Prescriptions and Formulae, 
conforming to the U. S. Pharmacopoeia, Directions for making 
Artificial Human Milk, for the Artificial Digestion of Milk, etc. 
Illustrated. Cloth, 3.00; Leather, 3.50 

Hatfield. Diseases of Children. By M. P. Hatfield, m.d., 
Professor of Diseases of Children, Chicago Medical College. 
Colored Plate. i2mo. Cloth, 1.00; Interleaved, 1.25 

Starr. Diseases of the Digestive Organs in Infancy and 
Childhood. With chapters on the Investigation of Disease, 
and on the General Management of Children. By Louis Starr, 
m.d., Clinical Professor of Diseases of Children in the Univer- 
sity of Pennsylvania. Illus. Second Edition. Cloth, 2.25 
4S* See pages 14 and 15 for list of? Quiz- Cotnpends? 



8 STUDENTS' TEXT-BOOKS AND MANUALS. 

DENTISTRY. 

Fillebrown. Operative Dentistry. 330 Illus. Cloth, 2.50 

Flagg's Plastics and Plastic Filling. 4th Ed. Cloth, 4.00 
Gorgas. Dental Medicine. Fourth Edition. Cloth, 3.50 

Harris. Principles and Practice of Dentistry. Including 
Anatomy, Physiology, Pathology, Therapeutics, Dental Surgery 
and Mechanism. Twelfth Edition. Revised and enlarged by 
Professor Gorgas. 1028 Illustrations. Cloth, 7.00 ; Leather, 8.00 
Richardson's Mechanical Dentistry. Fifth Edition. 569 
Illustrations. 8vo. Cloth, 4.50; Leather, 5.50 

Sewill. Dental Surgery. 200 Illustrations. 3d Ed. Clo., 3.00 
Taft's Operative Dentistry. Dental Students and Practitioners. 
Fourth Edition. 100 Illustrations. Cloth, 4.25 ; Leather, 5.00 
Talbot. Irregularities of the Teeth, and their Treatment. 
Illustrated. 8vo. Second Edition. Cloth, 3.00 

Tomes' Dental Anatomy. Third Ed. 191 Illus. Cloth, 4.00 
Tomes' Dental Surgery. 3d Edition. 292 Illus. Cloth, 5.00 
Warren. Compend of Dental Pathology and Dental Medi- 
cine. Illustrated. 2d Ed. Cloth, 1.00; Interleaved, 1.25 

DICTIONARIES. 

Gould's New Medical Dictionary. Containing the Definition 
and Pronunciation of all words in Medicine, with many useful 
Tables etc. y 2 Dark Leather, 3.25 ; ^ Mor., Thumb Index, 4.25 

Gould's Pocket Dictionary. 12,000 Medical Words Pro- 
nounced and Defined. Containing many Tables and an 
Elaborate Dose List. Thin 64mo. Just Ready. Leather, 1.00 

Harris' Dictionary of Dentistry. Fifth Edition. Completely 
revised by Prof. Gorgas. Cloth, 5.00; Leather, 6.00 

Cleaveland's Pronouncing Pocket Medical Lexicon. Small 
pocket size. Cloth, red edges .75 ; pocket-book style, 1.00 

Longley's Pocket Dictionary. The Student's Medical Lexicon, 
giving Definition and Pronunciation, with an Appendix giving 
Abbreviations used in Prescriptions, Metric Scale of Doses, etc. 
24mo. Cloth, 1. 00; pocket-book style, 1.25 

EYE. 

Hartridge on Refraction. 5th Edition. Illus. Cloth, 2.00 

Swanzy. Diseases of the Eye and their Treatment. 176 

Illustrations. Fourth Edition. Cloth, 3 00; Leather, 3.50 

Fox and Gould. Compend of Diseases of the Eye and 

Refraction. 2d Ed. "Enlarged. 71 Illus. 39 Formulae. 

Cloth, 1. 00 ; Interleaved for Notes, 1.25 

4£g=* See pages 2 to 5 for list 0/ Students' Manuals, 



STUDENTS' TEXT-BOOKS AND MANUALS. 9 

ELECTRICITY. 

Bigelow. Plain Talks on Medical Electricity. Cloth, i.oo 

Mason's Compend of Medical Electricity. Cloth, i.oo 

Steavenson and Jones. Medical Electricity. A Practical 

Handbook. Just Ready. Illustrated. i2mo. Cloth, 2.50 

HYGIENE. 

Coplin and Bevan. Practical Hygiene. By W. M. L. Cop- 
lin, Adjunct Professor of Hygiene, Jefferson Medical College, 
Philadelphia, and Dr. D. Bevan. Illustrated. In Press. 

Parkes' (Ed. A.) Practical Hygiene. Seventh Edition, en- 
larged. Illustrated. Svo. Cloth, 4.50 

Parkes' (L. C.) Manual of Hygiene and Public Health. 
Second Edition. i2mo. Cloth, 2.50 

Wilson's Handbook of Hygiene and Sanitary Science. 

Seventh Edition. Revised and Illustrated. Cloth, 3.25 

MATERIA MEDICA AND THERAPEUTICS. 

Potter's Compend of Materia Medica, Therapeutics, and 
Prescription "Writing. Fifth Edition, revised and improved. 
See page 15. Cloth, 1.00; Interleaved for Notes, 1.25 

Davis. Essentials of Materia Medica and Prescription 
Writing. By J. Aubrey Davis, m.d., Demonstrator of Obstet- 
rics and Quiz-Master on Materia Medica, University of Penn- 
sylvania. i2mo. Interleaved. Net, 1.50 

Biddle's Materia Medica. Twelfth Edition. By the late 
John B. Biddle, m.d. Revised by Clement Biddle, m.d. 8vo. 
Illustrated. Cloth, 4.25; Leather, 5.00 

Potter. Handbook of Materia Medica, Pharmacy, and 
Therapeutics. Including Action of Medicines, Special Thera- 
peutics, Pharmacology, etc. By Saml. O. L. Potter, m.d., 
m.r.c.p. (Lond.), Professor of the Practice of Medicine in 
Cooper Medical College, San Francisco. Fourth Revised and 
Enlarged Edition. 776 pages. 8vo. Cloth, 4.00; Leather, 5.00 

White and Wilcox. Materia Medica, Pharmacy, Phar- 
macology, and Therapeutics. A Handbook for Students. 
By Wm. Hale White, m.d., f.r.c.p., etc., Physician to and 
Lecturer on Materia Medica, Guy's Hospital. Revised by 
Reynold W. Wilcox, m.d., Professor of Clinical Medicine at the 
New York Post Graduate Medical School, Assistant Physician 
Bellevue Hospital, etc. American Edition. Clo., 3.00; Lea., 3.50 
*S* See pages 14 and ij for list of ? Quiz- Ccmpends ? 



10 STUDENTS' TEXT-BOOKS AND MANUALS. 

MEDICAL JURISPRUDENCE. 

Reese. A Text-book of Medical Jurisprudence and Toxi- 
cology. By John J. Reese, m.d., Professor of Medical Juris- 
prudence and Toxicology in the Medical Department of the 
University of Pennsylvania ; Physician to St. Joseph's Hospital. 
Third Edition. Cloth, 3.00; Leather, 3.50 

NERVOUS DISEASES. 

Gowers. Manual of Diseases of the Nervous System. 
A Complete Textbook. By William R. Gowers, m.d., Prof. 
Clinical Medicine, University College, London. Physician to 
National Hospital for the Paralyzed and Epileptic. Second 
Edition Revised, Enlarged, and in many parts Rewritten. 
With many new Illustrations. Octavo. 

Vol. I. Diseases of the Nerves and Spinal Cord. 616 

pages. Cloth, 3.50 

Vol. II. Diseases of the Brain and Cranial Nerves. 

General and Functional Diseases. Nearly Ready. 

Ormerod. Diseases of Nervous System, Student's Guide to. 
By J. A. Ormerod, m d., Oxon., f.r.c.p. (London), Member Path- 
ological Clinical, Ophthalmological, and Neurological Societies, 
Physician to National Hospital for Paralyzed and Epileptic and 
to City of London Hospital for Diseases of the Chest, Demon- 
strator of Morbid Anatomy, St. Bartholomew's Hospital, etc. 
With 75 Wood Engravings. Cloth, 2.00 

OBSTETRICS AND GYNECOLOGY. 

Davis. A Manual of Obstetrics. By Edw. P. Davis, Clinical 
Lecturer on Obstetrics, Jefferson Medical College, Philadelphia, 
Colored Plates, and 130 other Illustrations. i2mo. Cloth, 2.00 

Byford. Diseases of Women. The Practice of Medicine and 
Surgery, as applied to the Diseases and Accidents Incident to 
Women. By W. H. Byford, a.m., m.d., Professor of Gynaecology 
in Rush Medical College and of Obstetrics in the Woman's Med- 
ical College, etc., and Henry T. Byford, m.d., Surgeon to the 
Woman's Hospital of Chicago. Fourth Edition. Revised and 
Enlarged. 306 Illustrations, over 100 of which are original. 
Octavo 832 pages. Cloth, 5.00 ; Leather, 6.00 

Lewers' Diseases of Women. A Practical Text-book. 139 
Illustrations. Second Edition. Cloth, 2.50 

Parvin's Winckel's Diseases of Women. Second Edition. 
Including a Section on Diseases of the Bladder and Urethra. 
150 Illus. Revised. See page 3. Cloth, 3.00; Leather, 3.50 

Morris. Compend of Gynaecology. Illustrated. Cloth, 1.00 

Winckel's Obstetrics. A Text-book on Midwifery, includ- 
ing the Diseases of Childbed. By Dr. F. Winckel, Professor 
of Gynaecology, and Director of the Royal University Clinic for 
Women, in Munich. Authorized Translation, by J Clifton 
Edgar, m.d., Lecturer on Obstetrics, University Medical Col- 
lege, New York, with nearly 200 handsome Illustrations, the 
majority of which are original. 8vo. Cloth, 6.00; Leather, 7.00 

£S§=- See pages 2 to 5 for list of Nnu Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 11 

Obstetrics and Gynecology ; — Continued. 
Landis' Compend of Obstetrics. Illustrated. 4th Edition, 
Enlarged. Cloth, 1.00; Interleaved for Notes, 1.25 

Galabin's Midwifery. By A. Lewis Galabin, m.d., f.r.c.p." 
227 Illustrations. See page 3. Cloth, 3.00; Leather, 3.50 

PATHOLOGY, HISTOLOGY, ETC. 

Wethered. Medical Microscopy. By Frank J. Wethered, 
m.d., m.r.c.p. 98 Illustrations. ' Cloth, 2.50 

Bowlby. Surgical Pathology and Morbid Anatomy, for 
Students. 135 Illustrations. i2mo. Cloth, 2.00 

Gilliam's Essentials of Pathology. A Handbook for Students. 
47 Illustrations. 121E0. Cloth, 2.00 

Virchow's Post-Mortem Examinations. 3d Ed. Cloth, 1.00 

PHYSICAL DIAGNOSIS. 

Fenwick. Student's Guide to Physical Diagnosis. 7th 
Edition. 117 Illustrations. i2mo. Cloth, 2.25 

Tyson's Student's Handbook of Physical Diagnosis. Illus- 
trated. i2mo. Cloth, 1.25 

PHYSIOLOGY. 

Yeo's Physiology. Fifth Edition. The most Popular Stu- 
dents' Book. By Gerald F. Yeo, m.d., f.r.c.s., Professor of 
Physiology in King's College, London. Small Octavo. 758 
pages. 321 carefully printed Illustrations. With a Full 
Glossary and Index. Seepages. Cloth, 3.00; Leather, 3.50 

Brubaker's Compend of Physiology. Illustrated. Sixth 
Edition. Cloth, 1.00; Interleaved for Notes, 1.25 

Kirke's Physiology. New 13th Ed. Thoroughly Revised and 
Enlarged. 502 Illustrations, some of which are printed in colors. 
(Biakiston's Authorized Edition.) Cloth, 4.00; Leather, 5.00 

Landois' Human Physiology. Including Histology and Micro- 
scopical Anatomy, and with special reference to Practical Medi- 
cine. Fourth Edition. Translated and Edited by Prof. Stirling. 
845 Illustrations. Cloth, 7.00; Leather, 8.00 

M With this Text-book at his command, no student could fail in 

his examination." — Lancet. 

Sanderson's Physiological Laboratory. Being Practical Ex- 
ercises for the Student. 350 Illustrations. 8vo. Cloth, 5.00 

PRACTICE. 

Taylor. Practice of Medicine. A Manual. By Frederick 
Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's 
Hospital, London ; Physician to Evelina Hospital for Sick Chil- 
dren, and Examiner in Materia Medica and Pharmaceutical 
Chemistry, University of London. Cloth, 2.00; Leather, 2.50 

jCf^* See pages 14 and 15 for list 0/ ? Quiz-Compends ? 



12 STUDENTS' TEXT-BOOKS AND MANUALS. 

Practice : — Continued. 

Roberts' Practice. New Revised Edition. A Handbook 
of the Theory and Practice of Medicine. By Frederick T. 
Roberts, m.d., m.r.c.p., Professor of Clinical Medicine and 
Therapeutics in University College Hospital, London. Seventh 
Edition. Octavo. Cloth, 5.50 ; Sheep, 6.50 

Hughes. Compend of the Practice of Medicine. 4th Edi- 
tion. Two parts, each, Cloth, 1.00; Interleaved for Notes, 1.25 
Part i. — Continued, Eruptive and Periodical Fevers, Diseases 

of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 

Kidneys, etc., and General Diseases, etc. 

Part ii. — Diseases of the Respiratory System, Circulatory 

System, and Nervous System ; Diseases of the Blood, etc. 

Physicians' Edition. Fourth Edition. Including a Section 
on Skin Diseases. With Index. 1 vol, Full Morocco, Gilt, 2.50 

From John A. Robinson , M.D., Assistant to Chair of Clinical 
Medicine, now Lecturer on Materia Medica, Rush Medical Col- 
lege, Chicago. 
" Meets with my hearty approbation as a substitute for the 

ordinary note books almost universally used by medical students. 

It is concise, accurate, well arranged, and lucid, . . . just the 

thing for students to use while studying physical diagnosis and the 

more practical departments of medicine. " 

PRESCRIPTION BOOKS. 

Wythe's Dose and Symptom Book. Containing the Doses 
and Uses of all the principal Articles of the Materia Medica, etc. 
Seventeenth Edition. Completely Revised and Rewritten. Just 
Ready. 321110. Cloth, 1. 00; Pocket-book style, 1.25 

Pereira's Physician's Prescription Book. Containing Lists 
of Terms, Phrases, Contractions, and Abbreviations used in 
Prescriptions, Explanatory Notes, Grammatical Construction of 
Prescriptions, etc., etc. By Professor Jonathan Pereira, m.d. 
Sixteenth Edition. 321110. Cloth, 1. 00; Pocket-book style, 1.25 

PHARMACY. 

Stewart's Compend of Pharmacy. Based upon Remington's 
Text-book of Pharmacy. Third Edition, Revised. With new 
Tables, Index, Etc. Cloth., 1.00 ; Interleaved for Notes, 1.25 

Robinson. Latin Grammar of Pharmacy and Medicine. 

By H. D. Robinson, ph.d., Professor of Latin Language and 
Literature, University of Kansas, Lawrence. With an Intro- 
duction by L. E. Sayre, ph.g., Professor of Pharmacy in, and 
Dean of, the Dept. of Pharmacy, University of Kansas. i2mo. 

Cloth, 2.00 

SKIN DISEASES. 

Crocker. Diseases of the Skin, their Description, Pathology, 
Diagnosis, and Treatment, with Special Reference to the Skin 
truptions of Children. By H. Radcliffe Crocker, f.r.c p., Phy- 
sician for Diseases of the Skin in University College Hospital. 
Second Edition. Revised and Enlarged, with 92 Wood-cuts. 

Cloth, 5.00 

Van Harlingen on Skin Diseases. A Handbook of the Dis- 
eases of the Skin. By Arthur Van Harlingen, m.d. 2d Edition. 
Enlarged. 121110. Cloth, 2.50 

4Qf See pages 2 to J for list of New Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 13 
SURGERY AND BANDAGING. 

Moullin's Surgery. 500 Illustrations (some colored), 200 of 
which are original. 2d Ed. Cloth, net 7.00; Leather, net 8.00 

Jacobson. Operations in Surgery. A Systematic Handbook 
for Physicians, Students, and Hospital Surgeons. By W. H. A. 
Jacobson, b.a. Oxon., f.r.c.s. Eng. ; Ass't Surgeon Guy's Hos- 
pital ; Surgeon at Royal Hospital for Children and Women, etc. 
199 Illustrations. 1006 pages. 8vo. Cloth. 5.00; Leather, 6.00 

Heath's Minor Surgery, and Bandaging. Ninth Edition. 142 
Illustrations. 60 Formulae and Diet Lists. Cloth, 2.00 

Horwitz's Compend of Surgery, Minor Surgery and 
Bandaging, Amputations, Fractures, Dislocations, Surgical 
Diseases, and the Latest Antiseptic Rules, etc., with Differential 
Diagnosis and Treatment. By Orville Hokwitz, b.s., m.d., 
Demonstrator of Surgery, Jefferson Medical College. 5th Edition. 
Enlarged and Rearranged. Many new Illustrations and Formulae. 
i2mo. Cloth, 1. 00 ; Interleaved for the addition of Notes, 1.25 
*^*The new Section on Bandaging and Surgical Dressings con- 
sists of 32 Pages and 41 Illustrations. Every Bandage of any 
importance is figured. This, with the Section on Ligation of 
Arteries, forms an ample Text-book for the Surgical Laboratory. 

Walsham. Manual of Practical Surgery. Third Edition. 
By Wm. J. Walsham, m.d., f.r c.s., Asst. Surg, to, and Dem- 
of Practical Surg, in, St. Bartholomew's Hospital ; Surgeon to 
Metropolitan Free Hospital, London. With 318 Engravings. 
See page 2. Cloth, 3.00; Leather, 3.50 

URINE, URINARY ORGANS, ETC. 

Holland. The Urine, and Common Poisons and The 
Milk. Chemical and Microscopical, for Laboratory Use. Illus- 
trated. Fourth Edition. i2mo. Interleaved. Cloth, 1.00 

Ralfe. Kidney Diseases and Urinary Derangements. 42 Illus- 
trations. i2mo. 572 pages. Cloth, 2.75 

Marshall and Smith. On the Urine. The Chemical Analysis ot 
the Urine. By John Marshall, m.d., Chemical Laboratory, Univ. 
of Penna; and Prof. E. F. Smith, ph. d. Col. Plates. Cloth, 1. 00 

Memminger. Diagnosis by the Urine. Illustrated. 

Cloth, 1. 00 

Tyson. On the Urine. A Practical Guide to the Examination 
of Urine. With Colored Plates and Wood Engravings. 7th Ed. 
Enlarged. i2mo. Cloth, 1.50 

Van Niiys, Urine Analysis. Illus. Cloth, 2.00 

VENEREAL DISEASES. 

Hill and Cooper. Student's Manual of Venereal Diseases, 
with Formulae. Fourth Edition. i2mo. Cloth, 1.00 

4S=* See pages 14 and ij for list of f Quiz- Commends f 



PQUIZ-COMPENDS? 

The Best Compends for Students' Use 
in the Quiz Class, and when Pre- 
paring for Examinations. 

Compiled in accordance with the latest teachings of promi- 
nent Lecturers and the most popular Text-books. 

They form a most complete, practical, and exhaustive 
set of manuals, containing information nowhere else col- 
lected in such a condensed, practical shape. Thoroughly 
up to the times in every respect, containing many new 
prescriptions and formulae, and over two hundred and 
fifty illustrations, many of which have been drawn and 
engraved specially for this series. The authors have had 
large experience as quiz-masters and attaches of colleges, 
with exceptional opportunities for noting the most recent 
advances and methods. 

Cloth, each $1.00. Interleaved for Notes, $1.25. 
No. 1. HUMAN ANATOMY, " Based upon Gray." Fifth 
Enlarged Edition, including Visceral Anatomy, formerly 
published separately. 16 Lithograph Plates, New 
Tables, and 117 other Illustrations. By Samuel O. L. 
Potter, m. a., m.d., m.r.c.p. (Lond.), late A. A. Surgeon U. S. 
Army, Professor of Practice, Cooper Medical College, San Fran- 
cisco. 
Nos. 2 and 3. PRACTICE OF MEDICINE. Fourth Edi- 
tion. By Daniel E. Hughes, m.d., Demonstrator of Clinical 
Medicine in Jefferson Medical College, Philadelphia. In two parts. 
Part I. — Continued, Eruptive, and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc. (including Tests for Urine), General Diseases, etc. 

Part II. — Diseases of the Respiratory System (including Phy- 
sical Diagnosis), Circulatory System, and Nervous System; Dis- 
eases of the Blood, etc. 

*^* These little hooks can be regarded as a full set of notes upon 
the Practice of Medicine, containing the Synonyms, Definitions, 
Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each 
disease, and including a number of prescriptions hitherto unpub- 
lished. 

No. 4. PHYSIOLOGY, including Embryology. Sixth 
Edition. By Albert P. Brubaker. m.d., Prof, of Physiology, 
Penn'a College of Dental Surgery; Demonstrator of Physiology 
in Jefferson Medical College, Philadelphia. Revised, Enlarged, 
with new Illustrations. 

No. 5. OBSTETRICS. Illustrated. Fourth Edition. By 
Henry G. Landis, m.d., Prof, of Obstetrics and Diseases of 
Women in Starling Medical College, Columbus, O. Revised 
Edition. New Illustrations. 



BLAKISTON'S ? QUIZ-COMPENDS ? 

No. 6. MATERIA MEDICA, THERAPEUTICS, AND 
PRESCRIPTION WRITING. Fifth Revised Edition. 
With especial Reference to the Physiological Action of Drugs, 
and a complete article on Prescription Writing. Based on the 
Last Revision of the U. S. Pharmacopoeia, and including many 
unofhcinal remedies. By Samuel O. L. Potter, m.a., m.d., 
m.r.c.p (Lond.), late A. A. Surg. U. S. Army ; Prof, of Practice, 
Cooper Medical College, San Francisco. Improved and Enlarged, 
with Index. 

No. 7. GYNAECOLOGY. A Compend of Diseases of Women. 
By Henry Morris, m.d., Demonstrator of Obstetrics, Jefferson 
Medical College, Philadelphia. 45 Illustrations. 

No. 8. DISEASES OF THE EYE AND REFRACTION, 
including Treatment and Surgery. By L. Webster Fox, m.d., 
Chief Clinical Assistant Ophthalmological Dept.', Jefferson Med- 
ical College, etc., and Geo. M. Gould, m.d. 71 Illustrations, 39 
Formulae. Second Enlarged and improved Edition. Index. 

No. 9. SURGERY, Minor Surgery and Bandaging. Illus- 
trated. Fourth Edition. Including Fractures, Wounds, 
Dislocations, Sprains, Amputations, and other operations; Inflam- 
mation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. 
Diseases of the Spine, Ear, Bladder, Testicles, Anus, and 
other Surgical Diseases. By Orville Horwitz, a.m., m.d., 
Demonstrator of Surgery, Jefferson Medical College. Revised 
and Enlarged. 84 Formulae and 136 Illustrations. 

No. 10. CHEMISTRY. Inorganic and Organic. For Medical 
and Dental Students. Including Urinary Analysis and Medical 
Chemistry. By Henry Leffmann, m.d., Prof, of Chemistry in 
Penn'a College of Dental Surgery, Phila. Third Edition, Revised 
and Rewritten, with Index. 

No. 11. PHARMACY. Based upon " Remington's Text-book 
of Pharmacy." By F. E. Stewart, m.d., ph.g. , Quiz-Master 
at Philadelphia College of Pharmacy. Third Edition, Revised. 

No. 12. VETERINARY ANATOMY AND PHYSIOL- 
OGY. 29 Illustrations. By Wm. R Ballou, m.d., Prof, of 
Equine Anatomy at N Y. College of Veterinary Surgeons. 

No. 13. DENTAL PATHOLOGY AND DENTAL MEDI- 
CINE. Containing all the most noteworthy points of interest 
to the Dental student. Second Edition. By Geo. W. Warren, 
d.d.s., Clinical Chief, Penn'a College of Dental Surgery, Phila- 
delphia. Illustrated. 

No. 14. DISEASES OF CHILDREN. By Dr. Marcus P. 
Hatfield, Prof, of Diseases of Children, Chicago Medical 
College. Colored Plate. 

Bound in Cloth, $1. Interleaved, for the Addition of Notes, $1.25. 

Jg^g** These books are constantly revised to keep up with 
the latest teachings and discoveries, so that they contain 
all the new methods and principles. No series of books 
are so complete in detail, concise in language, or so well 
printed and bound. Each one forms a complete set of 
notes upon the subject under consideration. 

Illustrated Descriptive Circular Free. 



GOULD'S NEW 

Medical Dictionary. 

Based on Eecent Medical Literature. 



Small 8vo, Half Morocco, as above, with Thumb Index, . . $4.25. 
Plain Dark Leather, without Thumb Index, 3.25 



A compact, concise Vocabulary, including all 
the Words and Phrases used in medicine, with 
their proper Pronunciation and Definitions. 



"One pleasing feature of the book is that the reader can almost 
invariably find the definition under the word he looks for, without 
being referred from one place to another, as is too commonly the 
case in medical dictionaries. The tables of the bacilli, micrococci, 
leucomai'nes and ptomaines are excellent, and contain a large 
amount of information in a limited space. The anatomical tables 
are also concise and clear. . . . We should unhesitatingly 
recommend this dictionary to our readers, feeling sure that it will 
prove of much value to them." — American Journal of Medical 
Science. 

JUST PUBLISHED. 
GOULD'S POCKET DICTIONARY. 12,000 
Medical Words Pronounced and Denned. 

Cloth, $1.00; Leather, #1.25 



